Medical Director, Utilization Management & Payer Strategy

Council Capital; Nashville (TN); On-site; USD 180,000 - 320,000; Full time

Job summary

Council Capital, a Nashville-based healthcare-focused private equity firm, seeks a physician leader for Utilization Management. You will provide clinical oversight, lead physician-to-physician payer reviews, and guide documentation standards to support medical necessity determinations.

You will collaborate with UM leadership, Revenue Cycle, Compliance, and Operations, bringing judgment, data-informed decision making, and strategic healthcare insight to drive outcomes.

Qualifications

• MD or DO with an active, unrestricted medical license.
• Board Certified in a relevant specialty.
• Experience in Utilization Management or physician advisory roles.
• Strong understanding of medical necessity and payer criteria.
• Ability to communicate with clinicians and leaders.

Responsibilities

• Serve as the primary physician resource for UM decision-making and complex case reviews.
• Provide clinical oversight for medical necessity determinations.
• Support concurrent and retrospective review processes as needed.
• Lead physician-to-physician reviews with payers to support approvals.
• Partner with UM and Revenue Cycle teams to improve payer communication.
• Educate providers on documentation and payer criteria; support audit response.
• Collaborate across Case Management, UM leadership, Revenue Cycle, Compliance and Operations.

Skills

Clinical Judgment

Influence Without Authority

Communication

Decision-Making

Business Acumen

Education

MD/DO with license

Board Certification

Job description

Council Capital, a Nashville-based healthcare-focused private equity firm, seeks a physician leader for Utilization Management. You will provide clinical oversight, lead physician-to-physician payer reviews, and guide documentation standards to support medical necessity determinations.

You will collaborate with UM leadership, Revenue Cycle, Compliance, and Operations, bringing judgment, data-informed decision making, and strategic healthcare insight to drive outcomes.