Remote Medical Director, Utilization Management

Bickham Services Unlimited, LLC; New Jersey; Remote; USD 152,000 - 234,000; Full time

Job summary

Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization reviews for inpatient and post-acute care, ensuring medical necessity determinations align with CMS, policies, and evidence-based criteria.

Remote opportunity in New Jersey for a board-certified physician with strong leadership in managed care, responsible for regulatory compliance, quality initiatives, and collaboration with care management teams.

Qualifications

• MD/DO license active in good standing.
• Board-certified in medical specialty.
• 5+ years clinical experience, 3+ in UM or medical leadership within managed care.

Responsibilities

• Lead and support clinical utilization management activities for inpatient and post-acute reviews.
• Review post-acute services (SNF, IRF, LTACH, home health) for medical necessity.
• Apply CMS criteria, medical policies, and evidence-based practices to determinations.

Skills

Clinical leadership

Utilization management

Regulatory knowledge

Education

MD/DO degree

Board certification

Tools

MCG guidelines

InterQual

Job description

Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization reviews for inpatient and post-acute care, ensuring medical necessity determinations align with CMS, policies, and evidence-based criteria.

Remote opportunity in New Jersey for a board-certified physician with strong leadership in managed care, responsible for regulatory compliance, quality initiatives, and collaboration with care management teams.