Medical Director, Utilization Management

Ladders; United States; Remote; USD 180,000 - 220,000; Full time

Benefits offered by this job

Medical/dental/vision

401(k) matching

Flexible time-off

Remote-first culture

Mentorship programs

ESPP

Tech stipends

Job summary

Ladders is seeking a Medical Director, Utilization Management to provide clinical leadership for utilization review, ensuring medically necessary and timely care in a remote-first setting.

Responsibilities include peer-to-peer discussions, mentoring UM nurses, reviewing authorization requests, and contributing to clinical guidelines, with a focus on patient-centered care and Medicare Advantage expertise.

Qualifications

• MD or DO degree required.
• Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or related specialty.
• Valid, unrestricted medical license in a U.S. state.
• Minimum of five years of clinical experience.
• At least one year of experience as a utilization management reviewer.
• Experience with Medicare Advantage.
• Commitment to patient-centered care and technology utilization.

Responsibilities

• Participate in utilization management processes.
• Support quality improvement initiatives for members.
• Review authorization requests for medical necessity.
• Evaluate authorizations for medical services within required timelines.
• Conduct peer-to-peer discussions with providers.
• Mentor and coach UM nurses to enhance effectiveness.
• Contribute to the development of clinical guidelines and policies.

Skills

Medical leadership

Utilization management

Healthcare collaboration

Clinical decision making

Peer discussions

Education

MD or DO

Board Certification (Internal/Family/Emergency Medicine)

Unrestricted US medical license

Job description

For our client, we are seeking a Medical Director, Utilization Management to join the team of a leader in the Healthcare space. In this role, you will provide clinical leadership for utilization management activities that help ensure members receive medically necessary, timely, and appropriate care. You will partner closely with care teams, reviewing physicians, and quality leaders to strengthen decision-making, support better outcomes, and advance evidence-based clinical standards. This position combines physician-level review, peer collaboration, and process improvement in a remote-first environment focused on patient-centered care.

Location: Remote

Compensation: $180,000 – $220,000 annually

Responsibilities

• Participate in utilization management processes
• Support quality improvement initiatives for members
• Review authorization requests for medical necessity
• Evaluate authorizations for medical services within required timelines
• Conduct peer-to-peer discussions with providers
• Mentor and coach UM nurses to enhance effectiveness
• Contribute to the development of clinical guidelines and policies

Qualifications

• MD or DO degree required
• Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or a related specialty
• Valid, unrestricted medical license in a U.S. state
• Minimum of five years of clinical experience
• At least one year of experience as a utilization management reviewer
• Experience with Medicare Advantage
• Commitment to patient-centered care and technology utilization

Benefits

• Comprehensive medical, dental, and vision coverage
• 401(k) matching and performance-based bonuses
• Flexible time-off policy and mental health resources
• Remote-first culture promoting work-life balance
• Professional development funding and mentorship programs
• Employee stock purchase plan (ESPP)
• Reimbursement for office setup expenses and monthly stipends for cell phone and internet

Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.