Remote Utilization Management Medical Director

SCAN; Los Angeles (CA); Remote; USD 213,000 - 308,000; Full time

Benefits offered by this job

Mostly Remote Work

Annual bonus program

Wellness program

PTO & holidays

401(k) plan with employer match

Tuition reimbursement

HQ travel once a month

Job summary

SCAN is seeking an Utilization Management Physician Medical Director to lead medical necessity determinations, prior authorizations, and reviews. This physician will influence policy, provide clinical mentorship, and ensure compliant, evidence-based decision-making while collaborating with RN reviewers and UM leadership.

The role requires an active MD/DO license and board certification, 5+ years of clinical practice, and 2–3 years in utilization management.

Qualifications

• Graduate of an accredited medical school required.
• Medical License (MD/DO) required and active.
• Board certification in a relevant specialty.
• Minimum 5 years of active clinical practice.
• 2–3 years in utilization management or managed care.

Responsibilities

• Perform physician-level medical necessity review for prior authorization and reviews.
• Render timely determinations per Medicare guidelines and evidence-based criteria.
• Conduct peer-to-peer discussions with treating physicians.
• Serve as reviewer for first-level appeals and participate in external reviews.
• Maintain availability for urgent/expedited reviews within turnaround windows.
• Partner with UM leadership to set policy and criteria adoption.

Skills

Clinical leadership

Peer-to-peer discussions

Analytical skills

Communication skills

Mentorship / calibration

UM platforms / EHRs

Education

MD/DO degree

Board certification (Internal/Family/Emergency Medicine)

Tools

UM/clinical workflow platforms

Electronic Health Records (EHR)

Job description

SCAN is seeking an Utilization Management Physician Medical Director to lead medical necessity determinations, prior authorizations, and reviews. This physician will influence policy, provide clinical mentorship, and ensure compliant, evidence-based decision-making while collaborating with RN reviewers and UM leadership.

The role requires an active MD/DO license and board certification, 5+ years of clinical practice, and 2–3 years in utilization management.