Medical Director, Utilization Management & Payer Reviews

Council Capital; United States; À distance; USD 180 000 - 270 000; Plein temps

Résumé du poste

Council Capital, a healthcare-focused private equity firm based in Nashville, TN, seeks a physician advisor to lead utilization management decisions and ensure medical necessity. You will oversee clinical reviews, conduct peer-to-peer payer discussions to secure authorizations, overturn denials, and educate providers on documentation to support audits.

Requires MD/DO with license and board certification, UM experience, and strong payer criteria knowledge with clear clinician communication.

Qualifications

• MD/DO with active unrestricted medical license and board certification.
• Prior experience in UM, physician advisory, or medical review.
• Strong understanding of payer criteria and effective clinician communication.

Responsabilités

• Lead UM decisions and clinical oversight for medical necessity.
• Conduct peer-to-peer payer reviews to support authorizations and overturn denials.
• Educate providers on documentation and support audit response.

Connaissances

Clinical knowledge or payer criteria

Formation

MD/DO with active unrestricted medical license and board certification

Description du poste

Council Capital, a healthcare-focused private equity firm based in Nashville, TN, seeks a physician advisor to lead utilization management decisions and ensure medical necessity. You will oversee clinical reviews, conduct peer-to-peer payer discussions to secure authorizations, overturn denials, and educate providers on documentation to support audits.

Requires MD/DO with license and board certification, UM experience, and strong payer criteria knowledge with clear clinician communication.