Remote Medical Director, Utilization Mgmt

Harris Jones Staffing Recruiting Llc; Eagan (MN); Remote; USD 120,000 - 160,000; Part time

Job summary

HJ Staffing is seeking an experienced physician leader for a remote Medical Director, Utilization Management (Home Health, Acute & Post-Acute) role. You will serve as the primary clinical authority for home health authorization requests and support appeals and reviews for Medicare Advantage populations.

Remote role with EST business hours, part-time/contract (6 months, potential extension). You will collaborate with UM staff and external agencies to drive evidence-based care and optimal resource

Qualifications

• MD or DO, active licensure in any U.S. jurisdiction.
• Minimum 5+ years of direct clinical patient care experience.
• 1–2+ years of Utilization Management physician reviewer experience.
• Direct experience reviewing home health, acute and post-acute services under Medicare Advantage guidelines.

Responsibilities

• Evaluate outpatient referrals, inpatient admissions, and home health authorization requests for medical necessity.
• Review complex medical necessity denials, appeals, reconsiderations, and coverage determinations.
• Conduct peer-to-peer discussions with treating physicians on coverage criteria and complex cases.
• Apply CMS guidelines, MCG criteria, and health plan policies to determinations.
• Lead and mentor Home Health RN Lead and UM staff with clinical guidance.
• Collaborate with external Home Health agency leadership on documentation standards.
• Contribute to updating clinical guidelines, policies, and quality improvement initiatives.
• Support tech-enabled care delivery and data-driven medical management.

Skills

Clinical leadership

Peer-to-peer discussions

Medical necessity reviews

CMS guidelines

Education

MD or DO

Tools

EHR systems

Job description

HJ Staffing is seeking an experienced physician leader for a remote Medical Director, Utilization Management (Home Health, Acute & Post-Acute) role. You will serve as the primary clinical authority for home health authorization requests and support appeals and reviews for Medicare Advantage populations.

Remote role with EST business hours, part-time/contract (6 months, potential extension). You will collaborate with UM staff and external agencies to drive evidence-based care and optimal resource