Medical Director, Utilization Management
$200k - $250kTalentLNX LLC
- Medical Director, Utilization ManagementManaged Care & Clinical ProgramsOrlando, FloridaOctober 5, 2026$230,000 - $275,000 / yearFull TimeApplication ends: **November 6, 2026**Apply Now### Job Description**Location:** Orlando, FL (Hybrid)We are seeking a **Medical Director, Utilization Management** to lead utilization management, coverage determinations, and clinical appeals for a national health plan, ensuring members receive the right care at the right time. This position is a full-time, direct hire opportunity based in the Orlando, FL area on a hybrid schedule. The role guides a utilization management team across prior authorization, concurrent review, and appeals, and serves as a clinical leader and educator for the department.This role is well aligned for a physician who is passionate about population health and clinical appropriateness and enjoys combining clinical expertise with leadership. The ideal candidate brings sound clinical judgment, strong regulatory knowledge, and a collaborative approach to working with treating physicians, nursing teams, and plan leadership.Responsibilities:* Direct utilization management activities, including prior authorization, concurrent review, and discharge planning* Render coverage determinations on complex cases using evidence based criteria* Conduct peer to peer reviews with treating physicians on adverse determinations* Lead clinical appeals and grievance reviews in accordance with regulatory requirements* Partner with nursing and care management teams to support appropriate care decisions* Develop and maintain utilization management policies, guidelines, and coverage criteria* Ensure compliance with URAC and NCQA accreditation and utilization management standards* Serve as a clinical educator and resource for the utilization management team* Monitor utilization management performance metrics and report findings to leadership**Qualifications:*** MD or DO with an active, unrestricted medical license required; multi-state licensure a plus* Board certification in a clinical specialty required, with Internal Medicine, Family Medicine, Emergency Medicine, or a specialty with UM relevance preferred* Minimum of 3 years of managed care, utilization management, or medical director experience* Experience in a health plan, managed care organization, or insurance environment strongly preferred* Strong working knowledge of InterQual or MCG clinical criteria and URAC and NCQA utilization management standards* Excellent clinical judgment, written communication, and leadership skills**Schedule:*** Full-time position* Hybrid schedule based in the Orlando, FL area, with a combination of onsite and remote days* Monday through Friday, standard business hours (Eastern Time)* 40 hours per week**Salary Range:** The salary range for this position is approximately $200,000 – $250,000 annually ($96.15 – $120.19 per hour), based on experience and qualifications.**Interview Process:**Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.---**Equal Opportunity Employer:** TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.
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Vacancy posted 2 days ago
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