Remote Medical Director, Utilization & Quality Leadership

Ladders; United States; Remote; USD 180,000 - 220,000; Full time

Benefits offered by this job

Medical/dental/vision

401(k) matching

Flexible time-off

Remote-first culture

Mentorship programs

ESPP

Tech stipends

Job summary

Ladders is seeking a Medical Director, Utilization Management to provide clinical leadership for utilization review, ensuring medically necessary and timely care in a remote-first setting.

Responsibilities include peer-to-peer discussions, mentoring UM nurses, reviewing authorization requests, and contributing to clinical guidelines, with a focus on patient-centered care and Medicare Advantage expertise.

Qualifications

• MD or DO degree required.
• Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or related specialty.
• Valid, unrestricted medical license in a U.S. state.
• Minimum of five years of clinical experience.
• At least one year of experience as a utilization management reviewer.
• Experience with Medicare Advantage.
• Commitment to patient-centered care and technology utilization.

Responsibilities

• Participate in utilization management processes.
• Support quality improvement initiatives for members.
• Review authorization requests for medical necessity.
• Evaluate authorizations for medical services within required timelines.
• Conduct peer-to-peer discussions with providers.
• Mentor and coach UM nurses to enhance effectiveness.
• Contribute to the development of clinical guidelines and policies.

Skills

Medical leadership

Utilization management

Healthcare collaboration

Clinical decision making

Peer discussions

Education

MD or DO

Board Certification (Internal/Family/Emergency Medicine)

Unrestricted US medical license

Job description

Ladders is seeking a Medical Director, Utilization Management to provide clinical leadership for utilization review, ensuring medically necessary and timely care in a remote-first setting.

Responsibilities include peer-to-peer discussions, mentoring UM nurses, reviewing authorization requests, and contributing to clinical guidelines, with a focus on patient-centered care and Medicare Advantage expertise.