Medical Director (Utilization Management)
WellSky Corporation
The Medical Director is responsible for providing oversight, medical guidance and support to the full spectrum of WellSky's clinical management acute, emergency department, and post-acute care solutions and programs. The scope of this job includes providing expertise and leadership in medical management, as well as care coordination activities for acute and post-acute care services. Location: This is a remote position. Candidates located within 50 miles of WellSky's headquarters in Overland Park, KS will join our WHQ community and participate in our in-office collaboration experience. WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference. Key Responsibilities: Lead improvements of post-acute clinical programs by driving strategy, design, and implementation. Provide timely expert medical review for acute (ED) and post-acute care services (SNF, IRF, LTACH, HH), provide a clinical opinion about the medical service under review (including post-decision reviews), and be available for escalations from the nurse teams. Document clinical review findings, actions, and outcomes per policy and in accordance with regulatory and accreditation requirements. Provide guidance for clinical operational aspects of the ED, acute, and post-acute care programs. Collaborate with acute ED providers to coordinate and/or support care transitions. Identify and develop opportunities for innovation to increase effectiveness and quality, including education development, training, and issue resolution. Participate in client JOCs or partner/stakeholder meetings as needed. Perform other job duties as assigned. Required Qualifications: Doctoral degree in a relevant medical field At least 6-8 years of relevant work experience Active, unrestricted medical license (MD or DO) Board certification in a relevant specialty (preferably in Physical Medicine and Rehabilitation, Internal Medicine, Emergency Medicine, or General Surgery) Job Expectations: Willing to travel up to 10% based on business needs Willing to work additional or irregular hours as needed Must work in accordance with applicable security policies and procedures to safeguard company and client information Must be able to sit and view a computer screen for extended periods of time
#LI-OF1
#LI-Remote Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky: Excellent medical with Rx, dental, and vision benefits Mental Health support through EAP Generous paid time off, plus 13 paid holidays 100% vested 401(K) retirement plans Educational assistance up to $2500 per year WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace. Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates. Data Privacy Notice for Job Applicants and Teammates #J-18808-Ljbffr WellSky Corporation$275k - $315k
...Title: Medical Director of Utilization Management Summary: Step into a strategic leadership position as the Clinical Lead for a prominent Health Plan's Utilization Management (UM) Department. You will oversee clinical strategy, quality improvement, and cost-effectiveness...SuggestedFull timeWork at officeRemote workMonday to FridayShift work2 days per week- HJ Staffing is urgently seeking a Medical Director of Utilization Management to join a leading Medicare Advantage Health Plan. This physician leader will play a critical role in ensuring the clinical integrity of inpatient and post-acute care reviews, evaluating medical...SuggestedFull timeRemote workMonday to Friday
- CVS Health is seeking a Medical Director to lead medical management for Medicaid populations with a national scope, primarily supporting Aetna Better... ...of Louisiana. In this remote role, you will oversee utilization management, prior authorizations, and peer-to-peer consultations...SuggestedRemote job
$26.01 - $56.14 per hour
...one family and one community at a time. Behavioral Health Utilization Management Clinician Remote | Louisiana Preferred | Sunday - Thursday... ...behavioral health services and treatment plans to determine medical necessity and appropriateness of care Apply evidence-based...SuggestedHourly payFull timeTemporary workLocal areaRemote work- A healthcare management organization is seeking a Remote Medical Director to lead the review of medical records and provide expert decision-making. This role demands a blend of clinical experience, leadership, and the ability to guide a team while ensuring compliance with...SuggestedRemote jobContract workWeekend work
- Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization reviews for inpatient and post-acute care, ensuring medical necessity determinations align with CMS, policies, and evidence-based criteria. Remote opportunity...Remote job
- ...specialty clinicians in the role of Medical Director . The Medical Director will partner in... ...University - our own built-in learning management system. RECOVER CPR... ...Embrace our commitment to innovation by utilizing cutting-edge diagnostic tools and perform...Full timeTemporary workRelocation package
- Altais seeks a Medical Director of Utilization and Medical Management to lead UM policy and collaborate with the Clinical Leadership team across California. The role focuses on ensuring high-quality, cost-effective care within the managed care framework. Responsibilities...
- Oversee medical necessity reviews for home health, acute, post-acute, and outpatient services for Medicare Advantage populations. Collaborate... ...to promote evidence-based care and appropriate resource utilization. Apply CMS regulations, coverage determinations, MCG criteria,...Remote jobPart time
$260k - $275k
Medical Director - Health Plan - Remote Salary Range: $260,000 - $275,000 per year Location: New York, NY Remote / Onsite... ...is responsible for supporting appropriate healthcare utilization through Utilization Management, medical necessity and appeal reviews, peer-to-peer...Remote jobContract workMonday to Friday$190k - $200k
We're seeking a board‑certified Medical Director (Internal Medicine or Family Practice) to support our team. This role is fully remote and focuses on utilization management (UM), quality review, and clinical oversight for high‑volume cases. You will work closely with...Full timeRemote work- ...Job Description Job Description The Manager, Utilization Management (UM) is responsible for... ...driving clinical quality outcomes, reducing medical loss ratio (MLR), decreasing avoidable... ...Care Management, Pharmacy, Medical Directors, and Clinical Operations to develop...Rotational programWeekend workAfternoon shift
- ...The Care Management Associate supports comprehensive coordination of medical services including Care Team intake, screening and supporting the implementation of care plans to promote effective utilization of healthcare services. Promotes/supports quality effectiveness...Work at officeRemote work
$191.15k - $305.85k
Job Description The Medical Director brings a unique set of knowledge and skills to the business... ...groups, and members as needed. Utilizes clinical knowledge and experience to support... ...Skills: Project planning and management Core Skills: Strategy Develops, collaborates...- Natera is seeking an Area Medical Director (AMD) to lead the MD-to-MD clinical presence across a defined geography in community oncology.... ..., field execution, and scientific credibility to accelerate utilization of Signatera and Altera. The role combines field engagement,...Remote job
- ...Alpha in their search for an Associate Medical Director in a remote capacity. Hello Alpha is seeking... ...: Clinical: Work with the CMO to manage the peer-review process of APPs... ...records in accordance with procedures utilizing our internal electronic health record system...Full timeWork at officeRemote work
- Assistant Medical Director Orthopedics - On Call or Full-Time Join to apply for the Assistant... ...Industry Health Care Job Level Senior Management Position Type Full-Time/Regular... ...month ago Ophthalmology - Remote 1099 Utilization Review Work Naturopathic Doctor (Part-...Full timeContract workPart timeFor contractorsReliefRemote work
- EmblemHealth in New York is looking for a physician leader to manage the daily clinical operations of the Medical Management Department, coordinating internal and... ...high-quality care. The role focuses on improving utilization across Internal Medicine, OB/GYN, Psychiatry,...
$256k
...Gotham Health, Broadway as Associate Medical Director. \n \n Our dedicated team at NYC... ...the best clinical practices and tools to manage patient health. As part of the largest... ...interpersonal relationships; consistently utilizes and facilitates strategies to encourage...Full timeImmediate startFlexible hoursWeekend workAfternoon shift- DescriptionResponsible for the overall clinical management of the practice and program assigned to... ...supervision of all clinical providers (medical) and monitoring the practice and on site... ...and assigned by the Regional Medical Director.Schedule will include at least one...Contract workTraineeshipWork at officeWeekend workAfternoon shift
- General Practice Care - Medical Director - Flushing, NY Flushing, United States | Posted on 06/02/2026 An exceptional veterinary hospital,... ...leader for this hospital is a veterinarian who is prepared to manage a team of doctors and medical staff, and successfully oversee...Relocation package
$130k - $190k
...and results-driven Practice Manager to join our Innovation and Practice... ...management, and resource utilization. Develop internal... ...including breastfeeding and related medical conditions), age, marital or... ...application process, please contact Director of Support Staff Stephanie...For contractorsWork at officeLocal area$170k - $200k
...Practice Management Professional BakerHostetler has an excellent opportunity for an experienced... ...will report directly to the firmwide Director of Practice Management and will work... ...timekeeper performance, and team utilization metrics; Annual practice group budget planning...Temporary workWork at officeShift work$120 - $135 per hour
...Stay for the culture. What You’ll Be Doing Cardiovascular Utilization Management Reviewer (Interventional Cardiologist) Are you ready to... ...setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your expertise in interventional...Remote jobFull timePart timeWork at officeFlexible hours- A diversified healthcare organization is seeking a clinical professional to lead medical management services. Responsibilities include overseeing utilization review, coordinating quality improvement initiatives, and collaborating with various clinical teams to ensure optimal...Remote jobFlexible hours
$80 per hour
...policies, state and federal regulations. Manages requests for services from providers, members... ...plan for you and your loved ones, Medical, Dental, Vision, Life and Disability Employer... ...policies, procedures, and protocols. Utilize clinical skills to assess and document...Daily paidWork experience placementFlexible hours- ...and clinical outcomes. As a Clinical Manager you will lead care delivery and clinical... ...transformations that improve throughput, utilization, and frontline performance for providers... ...competitive suite of benefits including medical, dental, vision, life, and long-term...Work experience placementLive inWork at officeLocal areaWorldwide
$175k - $200k
...Managing Veterinarian – Riverside Animal Hospital – Upper West Side, Manhattan, NY... ...We are seeking a Managing Veterinarian/Medical Director to lead Riverside Animal Hospital, a well... ...to support strong technician utilization and a smooth daily flow. Prime Manhattan...$250k - $275k
...privately held, multispecialty medical group in New York, providing... ...nursing home support, care management, and in-home care through... ...Nursing Home Regional Medical Director is an important member of... ...management activities including utilization review and case management...Work at office- ...recognized as an industry leader, employing cutting-edge technologies, management practices and strategic growth initiatives. Employee ownership... ...design, grading and drainage, stormwater management, site utilities, and permitting. Provide support to Practice Leaders to ensure...Contract workWork experience placementLocal area
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Medical Director (Utilization Management). Be the first to apply!
- director environmental health & safety New York, NY
- director of clinical education New York, NY
- health economics manager New York, NY
- lead clinical data manager New York, NY
- medical affairs manager New York, NY
- associate director clinical data management New York, NY
- clinical manager New York, NY
- remote healthcare project manager New York, NY
- entry level healthcare project manager New York, NY
- director of clinical quality New York, NY




