Remote Medical Director - Utilization Management (Contract)

Bickham Services Unlimited LLC; United States; Remote; USD 165,000 - 331,000; Part time

Job summary

Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization reviews and medical necessity determinations for inpatient and post-acute care. The role focuses on inpatient reviews, SNF/IRF/LTACH/home health, and ensuring compliance with CMS regulations and policies.

Responsibilities include coordinating with utilization and care management teams, applying MCG/InterQual and payer policies, and participating in peer-to-peer discussions with

Qualifications

• Active, unrestricted M.D. or D.O. license in good standing.
• Current board certification in an appropriate medical specialty.
• At least 5 years of clinical experience, including 3+ years in utilization management or medical leadership.

Responsibilities

• 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 services using MCG, InterQual, CMS criteria, and policies.
• Collaborate with UM and care management teams to support cost-effective care.
• Participate in peer-to-peer discussions with treating physicians.
• Ensure reviews are documented per CMS, NCQA, and state/federal requirements.

Skills

Utilization management

Medical leadership

Peer-to-peer discussions

Education

MD/DO license

Board certification

Tools

MCG

InterQual

CMS criteria

Job description

Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization reviews and medical necessity determinations for inpatient and post-acute care. The role focuses on inpatient reviews, SNF/IRF/LTACH/home health, and ensuring compliance with CMS regulations and policies.

Responsibilities include coordinating with utilization and care management teams, applying MCG/InterQual and payer policies, and participating in peer-to-peer discussions with