Medical Director, Utilization Management

TalentLNX LLC; Orlando, Northern (FL, KY); Hybrid; USD 200,000 - 250,000; Full time

Job summary

TalentLNX LLC is seeking a Medical Director, Utilization Management to lead utilization management, coverage determinations, and clinical appeals for a national health plan. This full-time, hybrid role is based in the Orlando, FL area with a blend of onsite and remote days.

You will guide a UM team across prior authorization, concurrent review, and appeals, acting as a clinical leader and educator while ensuring regulatory compliance and population health quality.

Qualifications

• MD or DO with an active, unrestricted medical license required; multi-state licensure a plus.
• Board certification in a clinical specialty required, with Internal Medicine, Family Medicine, Emergency Medicine, or a specialty with UM relevance preferred.

Responsibilities

• Direct utilization management activities including prior authorization, concurrent review, and discharge planning.
• Render coverage determinations on complex cases using evidence-based criteria.
• Conduct peer-to-peer reviews with treating physicians on adverse determinations.
• Lead clinical appeals and grievance reviews in accordance with regulatory requirements.
• Partner with nursing and care management teams to support appropriate care decisions.
• Develop and maintain utilization management policies, guidelines, and coverage criteria.
• Ensure compliance with URAC and NCQA accreditation and utilization management standards.
• Serve as a clinical educator and resource for the UM team.
• Monitor utilization management performance metrics and report findings to leadership.

Skills

Leadership

Clinical judgement

Regulatory knowledge

Collaboration

Written communication

Education

MD/DO degree

Board certification in clinical specialty

Tools

InterQual criteria

MCG criteria

Job description

# Medical Director, Utilization ManagementManaged Care & Clinical ProgramsOrlando, FloridaOctober 5, 2026$230,000 - $275,000 / yearFull TimeApplication ends: **November 6, 2026**Apply Now### Job Description**Location:** Orlando, FL (Hybrid)We are seeking a **Medical Director, Utilization Management** to lead utilization management, coverage determinations, and clinical appeals for a national health plan, ensuring members receive the right care at the right time. This position is a full-time, direct hire opportunity based in the Orlando, FL area on a hybrid schedule. The role guides a utilization management team across prior authorization, concurrent review, and appeals, and serves as a clinical leader and educator for the department.This role is well aligned for a physician who is passionate about population health and clinical appropriateness and enjoys combining clinical expertise with leadership. The ideal candidate brings sound clinical judgment, strong regulatory knowledge, and a collaborative approach to working with treating physicians, nursing teams, and plan leadership.Responsibilities:* Direct utilization management activities, including prior authorization, concurrent review, and discharge planning* Render coverage determinations on complex cases using evidence based criteria* Conduct peer to peer reviews with treating physicians on adverse determinations* Lead clinical appeals and grievance reviews in accordance with regulatory requirements* Partner with nursing and care management teams to support appropriate care decisions* Develop and maintain utilization management policies, guidelines, and coverage criteria* Ensure compliance with URAC and NCQA accreditation and utilization management standards* Serve as a clinical educator and resource for the utilization management team* Monitor utilization management performance metrics and report findings to leadership**Qualifications:*** MD or DO with an active, unrestricted medical license required; multi-state licensure a plus* Board certification in a clinical specialty required, with Internal Medicine, Family Medicine, Emergency Medicine, or a specialty with UM relevance preferred* Minimum of 3 years of managed care, utilization management, or medical director experience* Experience in a health plan, managed care organization, or insurance environment strongly preferred* Strong working knowledge of InterQual or MCG clinical criteria and URAC and NCQA utilization management standards* Excellent clinical judgment, written communication, and leadership skills**Schedule:*** Full-time position* Hybrid schedule based in the Orlando, FL area, with a combination of onsite and remote days* Monday through Friday, standard business hours (Eastern Time)* 40 hours per week**Salary Range:** The salary range for this position is approximately $200,000 – $250,000 annually ($96.15 – $120.19 per hour), based on experience and qualifications.**Interview Process:**Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.---**Equal Opportunity Employer:** TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.