Remote Utilization Management Medical Director

HJSRLLC; Eagan (MN); Remote; USD 165,000 - 248,000; Part time

Job summary

HJ Staffing is seeking an experienced physician leader for a remote Medical Director, Utilization Management role. You will serve as the primary clinical authority for home health authorizations and support acute, post-acute, appeals, and reviews for Medicare Advantage populations.

Collaborate with Home Health RN Lead, UM nursing staff, and providers, applying CMS and MCG criteria to drive evidence-based care and optimize resource utilization.

Qualifications

• MD or DO from an accredited medical school.
• Active, unrestricted state medical license (MD/DO) in any US jurisdiction.
• Board Certification in Internal Medicine, Family Medicine, PM&R, Emergency Medicine, or related specialty.
• Minimum 5+ years of direct clinical patient care experience.
• 1–2+ years as a physician reviewer in Utilization Management.

Responsibilities

• Evaluate outpatient referrals, inpatient admissions, and home health authorizations for medical necessity.
• Review denials, appeals, reconsiderations, and coverage determinations.
• Conduct peer-to-peer discussions with treating physicians on coverage criteria and care plans.
• Apply CMS guidelines, MCG criteria, and health plan policies to determinations.

Skills

Clinical leadership

Peer-to-peer discussions

Communication & tech skills

Regulatory knowledge

Education

MD or DO

Tools

EHR systems

Job description

HJ Staffing is seeking an experienced physician leader for a remote Medical Director, Utilization Management role. You will serve as the primary clinical authority for home health authorizations and support acute, post-acute, appeals, and reviews for Medicare Advantage populations.

Collaborate with Home Health RN Lead, UM nursing staff, and providers, applying CMS and MCG criteria to drive evidence-based care and optimize resource utilization.