Medical Director – Utilization Management & Worker's Compensation (Fully Remote)

Council Capital; United States; Remote; USD 180,000 - 270,000; Full time

Job summary

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.

Responsibilities

• 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.

Skills

Clinical knowledge or payer criteria

Education

MD/DO with active unrestricted medical license and board certification

Job description

• 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.

Required 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.

Preferred Experience:

• Experience with commercial payers and managed care.
• Documented success in peer-to-peer reviews overturning denials.
• Exposure to PE-backed or growth healthcare organizations.

Council Capital is a healthcare-focused private equity firm based in Nashville, TN, managing over $350M in committed capital. We invest in lower middle market healthcare companies and support founders through our Council Model of operators, investors, and value creation experts.