Medical Director

Must have: MD or DO, and currently licensed in Wisconsin Available to work Monday - Friday 8 AM - 5 PM CST hours Job Description: We are seeking a Medical Director to support utilization management and appeals oversight for a four-month engagement (April 1 – July 31) with the potential for extension based on business needs. This role will provide clinical leadership and adverse determination review across multiple lines of business, including Medicare Advantage, Commercial, and ACA plans. Responsibilities: Assist the Chief Medical Officer (CMO) with monitoring the availability, appropriateness, and medical necessity of care rendered by participating and out-of-plan providers. Participate in oversight and clinical decision-making for the Utilization Management (UM) program. Render denial determinations for services not considered medically necessary or deemed experimental, investigational, or unproven in accordance with regulatory and quality standards. Review and manage approximately 5–10 appeals per day. Ensure appeals turnaround times are met (same day for expedited; two days for standard). Sign off on adverse determinations. Support all lines of business including Medicare Advantage (MA), Commercial, and ACA. Requirements: Doctor of Medicine (MD or DO), licensed in the state of Wisconsin without restriction. Experience supporting multiple lines of business including ACA, Commercial, and Medicare Advantage. Available to work Monday - Friday 8 AM - 5 PM CST hours Proficiency with QuickBase, Microsoft Teams, and Microsoft Office Suite. Key Skills: Appeals review and adverse determinations Medical necessity review Multi-line of business expertise (MA, Commercial, ACA) Regulatory compliance and quality standards adherence Strong clinical judgment and decision-making Pay Range: 150-180 hr w2 Medical insurance Vision insurance 401(k) retirement savings plan Contact: View phone number on click.appcast.io View email address on click.appcast.io 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. #J-18808-Ljbffr