Medical Director, Physiatrist

Provide clinical oversight and medical direction for musculoskeletal and therapy related programs and services. Ensure clinical policies, guidelines, and practices align with evidence based PM&R and MSK standards of care and applicable regulatory requirements. Serve as the senior clinical authority for MSK related questions, escalations, and complex case reviews. Utilization Management, Appeals, and Denials Perform and oversee utilization management reviews for MSK services, including physical therapy, occupational therapy, and related interventions. Conduct medical necessity determinations for prior authorization, concurrent, and retrospective reviews. Review and adjudicate clinical appeals and denials, including peer to peer discussions with ordering and rendering providers. Collaborate with operational and compliance teams to ensure utilization management activities meet contractual, regulatory, and accreditation standards. Client Facing Clinical Leadership Act as a client facing clinical leader and PM&R specialist for Health Network One’s MSK service lines. Participate in client meetings, presentations, and consultations to explain MSK clinical programs, utilization management decisions, and outcomes. Support client relationships, retention, and growth by providing credible, data driven clinical guidance. Represent Health Network One with external stakeholders, including health plans, provider partners, therapy networks, and regulatory entities, as appropriate. Strategic and Executive Partnership Partner with the CEO and executive leadership team to support strategic planning, clinical program design, and growth initiatives for MSK services. Provide clinical insight to inform organizational decision making, risk management, and performance improvement efforts. Contribute to the development and refinement of clinical workflows, quality initiatives, and performance metrics aligned with organizational goals. Compliance and Quality Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements. Support quality management activities related to MSK services, including audits, reporting, and corrective action planning. Promote a culture of clinical excellence, accountability, and evidence based decision making. Qualifications: Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with specialty training in Physical Medicine and Rehabilitation (PM&R)7+ years of progressive accounting experience, including leadership responsibility. Active, unrestricted medical license in at least one U.S. state, with the ability to obtain additional licensure as needed. Board certified or board eligible in Physical Medicine and Rehabilitation. Demonstrated experience with utilization management, medical necessity review, appeals, and denials for MSK services. Strong executive level communication skills, including the ability to engage effectively with clients, providers, and senior leaders. Preferred: Experience in managed care, health plans, MSOs, or delegated MSK or therapy services. Prior experience in a physician executive or client facing clinical leadership role. Familiarity with regulatory and accreditation standards related to utilization management and quality programs. Physician executive judgment and credibility. MSK and therapy clinical expertise. Client facing communication and presentation skills. Strong clinical decision making and documentation. Ability to balance clinical integrity with operational and business priorities. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr HS1