Remote Medical Director, Utilization Management

Bickham Services Unlimited LLC; United States; Remote; USD 180,000 - 240,000; Part time

Benefits offered by this job

Remote work

Job summary

Bickham Services Unlimited LLC is seeking a Medical Director, Utilization Management for a fully remote, 6-9 month contract with an immediate start. The role oversees inpatient and post-acute reviews for Commercial and Medicare Advantage members, ensuring medical necessity and appropriate care aligned with policies and CMS regulations.

The candidate will report to the Chief Medical Officer, lead physician reviewers, and collaborate with UM and care management teams to optimize outcomes and

Qualifications

• MD/DO degree with active, unrestricted medical license in the state of residence.
• Minimum five years of clinical experience, including at least three years in utilization management or medical leadership.
• Experience supporting Commercial and/or Medicare Advantage populations.

Responsibilities

• Conduct timely utilization reviews for inpatient admissions, continued stays, and post-acute care for Commercial and Medicare Advantage members.
• Assess appropriateness using MCG, InterQual, CMS criteria, and applicable policies.
• Collaborate with care teams to promote cost-effective, compliant care decisions.
• Participate in peer-to-peer discussions to clarify documentation and care levels.
• Contribute to development and interpretation of medical policies and UM protocols.
• Support regulatory compliance, audits, accreditation, and delegated oversight.
• Document reviews and rationales per CMS, NCQA, and state/federal requirements.

Skills

Utilization management

Clinical leadership

Data analysis

Regulatory awareness

Communication

Negotiation

Education

MD/DO degree

Active medical license (state residence)

Board certification

Tools

MCG guidelines

InterQual

Job description

Bickham Services Unlimited LLC is seeking a Medical Director, Utilization Management for a fully remote, 6-9 month contract with an immediate start. The role oversees inpatient and post-acute reviews for Commercial and Medicare Advantage members, ensuring medical necessity and appropriate care aligned with policies and CMS regulations.

The candidate will report to the Chief Medical Officer, lead physician reviewers, and collaborate with UM and care management teams to optimize outcomes and