Remote Medical Director, Utilization Management (6–9 mo Contract)

bickhamservices; Jersey City (NJ); Remoto; USD 96.000 - 165.000; Part-time

Descrizione del lavoro

Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization management activities for a commercial and Medicare Advantage program. The role focuses on inpatient and post-acute reviews to ensure timely, medically necessary determinations in line with member benefits and CMS requirements.

The position reports to the Chief Medical Officer with remote work, a 6–9 month contract length, and start ASAP.

Competenze

• Active, unrestricted MD or DO license in good standing.
• Current board certification in an appropriate medical specialty.
• 5+ years of clinical experience including utilization management within managed care.

Mansioni

• Conduct timely utilization reviews and medical necessity determinations for inpatient admissions and continued stays.
• Review post-acute care services including SNF, IRF, LTACH, and home health.
• Evaluate appropriateness of acute and post-acute services using CMS criteria and medical policies.
• Apply regulatory and coverage standards based on member's line of business.
• Serve as physician reviewer for escalated or complex cases.
• Participate in peer-to-peer discussions with treating physicians.
• Collaborate with UM and care management teams to support cost-efficient care.
• Identify utilization trends and support reduction of avoidable admissions.

Conoscenze

Utilization management leadership

Regulatory compliance

Peer-to-peer discussions

CMS and policy knowledge

Formazione

MD/DO license

Board certification

Descrizione del lavoro

Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization management activities for a commercial and Medicare Advantage program. The role focuses on inpatient and post-acute reviews to ensure timely, medically necessary determinations in line with member benefits and CMS requirements.

The position reports to the Chief Medical Officer with remote work, a 6–9 month contract length, and start ASAP.