Medical Director - Utilization Management & Appeals

REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS

$180/hour | W-2 Contract | Monday–Friday | 100% Remote | Potential Extension

The Jacobson Group is seeking a Medical Director to support a health plan's Utilization Management and Appeals programs. This is an excellent opportunity for a physician who enjoys clinical decision-making, medical necessity review, and appeals oversight without the responsibility of managing a staff.

You'll work across Medicare Advantage, Commercial, and ACA lines of business and partner with the Chief Medical Officer and UM team to ensure appropriate, high-quality, and medically necessary care.

WHY CONSIDER THIS OPPORTUNITY?

• $180/hour W-2
• 100% remote
• Monday–Friday, 8:00 AM–5:00 PM
• No direct staff management
• Work with Medicare Advantage, Commercial & ACA populations
• Focus on clinical judgment, medical necessity and appeals
• Contract currently expected through the end of the year, with potential for extension
• Medical, dental and vision benefits available
• 401(k) retirement savings plan

WHAT YOU'LL DO

• Support the CMO with oversight of the appropriateness, availability and medical necessity of care
• Participate in clinical decision-making for the Utilization Management program
• Review cases and render determinations when services do not meet medical necessity criteria or are considered experimental, investigational or unproven
• Review approximately 10–14 appeals per day
• Complete expedited appeals the same day and standard appeals within two days
• Provide final physician sign-off on adverse determinations
• Apply clinical judgment across Medicare Advantage, Commercial and ACA
• Collaborate with UM, clinical and operational teams to support regulatory and quality requirements

WHAT WE'RE LOOKING FOR

• MD or DO
• Active, unrestricted Wisconsin medical license OR willingness/ability to obtain Wisconsin licensure
• 3+ years of Utilization Management experience
• Experience with medical necessity review and adverse determinations
• Experience with Medicare Advantage, Commercial and/or ACA
• Appeals experience strongly preferred
• Strong clinical judgment and ability to make independent determinations
• Comfortable working remotely and managing a high-volume caseload

A GREAT FIT FOR PHYSICIANS WITH EXPERIENCE AS:

Medical Director | Physician Advisor | Utilization Management Medical Director | Appeals Medical Director | UM Physician | Health Plan Medical Director

Technology: QuickBase, Microsoft Teams and Microsoft Office

COMPENSATION & BENEFITS

$180/hour W-2

Benefits include:

• Medical insurance
• Dental insurance
• Vision insurance
• 401(k) retirement savings plan

Interested?

Contact Karrie Ruch with The Jacobson Group at View phone number on click.appcast.io or View email address on click.appcast.io

Refer a Colleague:

Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!

Equal Opportunity Employer:

The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs.

If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at View email address on click.appcast.io or View phone number on click.appcast.io to make a request.