Remote Medicare Advantage Utilization Medical Director

SCAN; California; Híbrido; USD 213.000 - 384.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Mostly remote work model

Annual employee bonus program

Wellness program

Generous PTO

401(k) with employer match

Employee recognition program

Descripción de la vacante

SCAN is seeking a Medicare Advantage UM Physician Medical Director to lead medical necessity reviews for prior authorization, concurrent, and retrospective cases. You will guide clinical criteria application, mentor RN reviewers, and participate in accreditation-related activities to ensure compliant, timely decisions.

The ideal candidate has board-certified Internal, Family, or Emergency Medicine credentials, 5+ years of clinical practice, and UM experience in health plans, with strong

Formación

• Graduate of an accredited medical school required.
• Board certification in good standing in a relevant specialty (Internal/Family/Emergency Medicine).

Responsabilidades

• Perform physician-level medical necessity review of prior authorizations, concurrent reviews, and retrospective reviews.
• Render determinations per Medicare guidelines, MCG criteria, and applicable state/federal requirements.
• Conduct peer-to-peer discussions and document clinical rationale clearly.
• Serve as reviewer for first-level appeals and refer to peer review when needed.
• Maintain availability for urgent/expedited reviews within required turnaround windows.
• Collaborate with UM leadership to set policy and escalation criteria.

Conocimientos

UM leadership

Peer-to-peer reviews

Regulatory knowledge

Analytics

Communication

Educación

Graduate of an accredited medical school

Board certification in Internal, Family or Emergency Medicine

Herramientas

EHR proficiency

Descripción del empleo

SCAN is seeking a Medicare Advantage UM Physician Medical Director to lead medical necessity reviews for prior authorization, concurrent, and retrospective cases. You will guide clinical criteria application, mentor RN reviewers, and participate in accreditation-related activities to ensure compliant, timely decisions.

The ideal candidate has board-certified Internal, Family, or Emergency Medicine credentials, 5+ years of clinical practice, and UM experience in health plans, with strong