Remote Medical Director - Utilization Management (Part-Time)

Jobgether SRL; United States; Remote; USD 70,000 - 110,000; Part time

Benefits offered by this job

Fully remote work environment

Part-time schedule (ET hours)

Job summary

Jobgether SRL is seeking a Medical Director, Utilization Management for Home Health, Acute and Post-Acute, fully remote and part-time in the United States. You will lead medical necessity reviews and mentor nursing teams while collaborating with providers to ensure evidence-based care and appropriate resource use.

You will apply CMS rules, National/Local Coverage Determinations, MCG guidelines, and health plan policies to complex cases, promoting quality outcomes and policy development.

Qualifications

• MD/DO degree from an accredited medical school.
• Active, unrestricted medical license in at least one U.S. jurisdiction.
• Board certification in Internal Medicine, Family Medicine, PM&R, Emergency Medicine or related field.
• 5+ years direct clinical patient care.
• 1–2 years as physician reviewer in utilization management.
• Experience evaluating home health and Medicare Advantage populations.
• Strong CMS coverage knowledge and evidence-based UM principles.

Responsibilities

• Evaluate outpatient referrals, inpatient admissions, and home health requests for medical necessity and level of care.
• Conduct peer-to-peer discussions regarding coverage criteria and complex cases.
• Apply CMS, Local/National determinations, and MCG guidelines to coverage determinations.
• Serve as physician advisor to Home Health RN Leads and UM nursing teams.
• Collaborate with home health leadership to promote proper documentation and best practices.
• Develop and refine utilization management policies and clinical guidelines.
• Partner with clinical operations on quality improvement initiatives and data-informed care.
• Promote technology-enabled medical management and reviewer workflows.
• Ensure consistency and accuracy in medical necessity evaluations.

Skills

Peer-to-peer communication

Mentorship

Evidence-based utilization management

CMS guidelines knowledge

Data-driven decision making

Remote collaboration

Education

MD/DO degree

Active medical license (US)

Board-certified in Internal/Family/PM&R/EM

Tools

EHR systems

Utilization management platforms

Job description

Jobgether SRL is seeking a Medical Director, Utilization Management for Home Health, Acute and Post-Acute, fully remote and part-time in the United States. You will lead medical necessity reviews and mentor nursing teams while collaborating with providers to ensure evidence-based care and appropriate resource use.

You will apply CMS rules, National/Local Coverage Determinations, MCG guidelines, and health plan policies to complex cases, promoting quality outcomes and policy development.