Medical Director – Utilization Management & Worker's Compensation

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 is a healthcare-focused private equity firm based in Nashville, Tennessee, managing over $350 million in committed capital.

We invest in lower middle market healthcare companies where we see the potential to scale purpose and performance. Our investments span control and minority positions in businesses with enterprise values between $10 million and $100 million.

What sets us apart is the Council Model—a proven framework that surrounds founders and leadership teams with a powerful combination of support: our CEO Council of seasoned operators, our Strategic Healthcare Investors who bring real-world insight and access, and our internal Value Creation Team, focused on enabling growth through talent, systems, and strategy.

At Council Capital, we’re not just backing companies—we’re helping build enduring businesses that improve lives and shape the future of healthcare.

Core Responsibilities (What the Role Does)

Utilization Management Leadership

• Serve as the primary physician resource for UM decision‑making, escalations, and complex case reviews

• Provide clinical oversight and guidance for medical necessity determinations

• Support concurrent and retrospective review processes as needed

Peer-to-Peer & Payer Engagement

• Conduct physician-to‑physician reviews with payers to support authorization approvals and overturn denials

• Partner with UM and Revenue Cycle teams to improve payer communication strategies

• Identify payer‑specific trends and opportunities to improve outcomes

Clinical Documentation & Education

• Educate providers on documentation best practices tied to medical necessity and payer criteria

• Identify recurring documentation gaps and implement corrective guidance

• Support audit preparation and response from a clinical perspective

Collaboration & Reporting

• Partner with Case Management, UM leadership, Revenue Cycle, Compliance, and Operations

• Provide insights and recommendations based on denial trends and utilization data

• Participate in leadership discussions related to utilization strategy and risk mitigation

Required Qualifications

• MD or DO with an active, unrestricted medical license

• Board Certified in a relevant specialty

• Prior experience in Utilization Management, Physician Advisory, Medical Review, or similar role

• Strong understanding of medical necessity, payer criteria, and utilization standards

• Ability to communicate effectively with both clinicians and non‑clinical leaders

Preferred Experience (Strongly Valued)

• Experience working with commercial payers and managed care organizations

• Prior peer‑to‑peer review experience with documented success overturning denials

• Experience in outpatient, post‑acute, or multi‑site healthcare services environments

• Exposure to healthcare services organizations operating in growth or PE‑backed environments

Core Competencies (Scorecard Competencies)

• Clinical Judgment – Applies sound, defensible medical decision‑making

• Influence Without Authority – Drives alignment across providers and payers

• Communication – Clear, concise, and persuasive physician‑to‑physician dialogue

• Decision‑Making – Timely, confident, and data-informed

• Business Acumen – Understands the financial and compliance implications of utilization decisions

What This Role Is Not

• Not a purely academic or advisory‑only position

• Not a full‑time practicing clinician role

• Not a compliance‑only or check‑the‑box function

This role requires ownership, judgment, and real engagement.

Council Capital and our portfolio companies are committed to building high‑performing teams by hiring the best talent—period.

We believe in putting the right people in the right seats, regardless of background, and we’re always looking for individuals who bring fresh thinking, grit, and a drive to make a difference.

Thank you for considering a role with one of our companies. We’re excited to learn more about you.