Clinical Medical Director, Utilization & Case Management

Children's Healthcare of Atlanta; Brookhaven (GA); On-site; USD 250,000 - 400,000; Full time

Job summary

Children’s Healthcare of Atlanta is seeking a Medical Director to provide administrative medical leadership across Utilization/Case Management, Patient Access, and related areas. The physician will support safe, timely discharges and work with case management to optimize outcomes.

The role requires board certification, Georgia licensure, DEA registration, and strong experience in hospital-based managed care and credentialing.

Qualifications

• Board-certified physician with Georgia medical license and DEA registration.
• Graduate of an accredited medical school and pediatrics residency.
• Experience in hospital-based administration and managed care.

Responsibilities

• Acts as clinical resource for utilization management staff to clarify medical necessity criteria.
• Leads or co-chairs committees related to utilization management and denial trends.
• Educates physicians about precertification, utilization review roles, and denials.
• Collaborates with Children’s and managed care leaders to improve processes and payor agreements.
• Reviews reports to ensure proper reimbursement and compliance with contracts.

Skills

Communication skills

Time management

Organizational skills

Relationship building

Regulatory knowledge

Education

Medical degree from accredited school

Pediatric residency

Job description

Children’s Healthcare of Atlanta is seeking a Medical Director to provide administrative medical leadership across Utilization/Case Management, Patient Access, and related areas. The physician will support safe, timely discharges and work with case management to optimize outcomes.

The role requires board certification, Georgia licensure, DEA registration, and strong experience in hospital-based managed care and credentialing.