Utilization Management - Medical Director

Job Description

New York Metro Area (Candidates Must Reside in NY, NJ, or CT)

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Full-Time | Hybrid Leadership Opportunity

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Total Compensation Range: $200k - $225k

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We are seeking an experienced Medical Director of Utilization Management to provide clinical leadership within a growing health plan environment serving Medicare and Medicaid populations.

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This is an outstanding opportunity for a physician who enjoys collaborating across multidisciplinary teams, driving quality outcomes, ensuring regulatory compliance, and helping members receive the right care at the right time.

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What You'll Do

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• Serve as the physician leader and clinical resource for Utilization Management operations.
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• Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations.
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• Partner with executive leadership to develop and execute medical management initiatives.
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• Monitor utilization trends and identify opportunities to improve quality, efficiency, and cost-effectiveness.
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• Participate in interdisciplinary care planning discussions to support coordinated member care.
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• Ensure compliance with federal, state, accreditation, and contractual requirements.
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• Support organizational readiness for audits, surveys, regulatory reviews, and investigations.
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• Utilize care management platforms to document clinical reviews and decision-making activities.
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• Evaluate utilization data and performance metrics to support strategic planning efforts.
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• Contribute to annual departmental goals and provide ongoing progress updates.
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• Maintain current knowledge of evolving Medicare, Medicaid, and managed care regulations.
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• Collaborate with quality, care management, pharmacy, and operational teams to improve health outcomes.
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Required

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• Medical Doctor (MD or DO) degree, licensed in NY.
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• Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or related specialty.
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• 3+ years of experience in health plan medical management.
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• Experience supporting Medicare and Medicaid products, including managed care populations.
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• Background in utilization management across inpatient and outpatient settings.
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• Experience performing appeals reviews and medical necessity determinations.
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• Strong knowledge of New York healthcare market dynamics.
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What Makes You Successful

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• Strategic thinker with strong clinical judgment.
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• Excellent communicator who can build relationships across departments.
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• Data-driven leader focused on quality improvement and member outcomes.
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• Strong understanding of healthcare regulations and managed care operations.
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• Passion for improving access, affordability, and quality of care.
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SEO Keywords

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Medical Director, Utilization Management, Physician Executive, Medical Management, Managed Care, Medicare, Medicaid, MLTC, MAP, MAPD, D-SNP, Appeals Review, Peer-to-Peer Review, Population Health, Value-Based Care, Health Plan Leadership, New York Physician Jobs

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Atlas Search is a tri-state area recruitment agency, connecting new graduates, Advanced Practice Providers, Physicians and Nurse Leaders to hospitals, clinics, multi-specialty groups, nursing homes, managed care companies, private practices, and healthcare start-ups.

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If you would like to learn more about the opportunities we offer, please submit your CV for consideration here.