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Medical Director – Utilization Management at Appworkshub. Location Information: USA. 🚨 . Now Hiring: Medical Director – Utilization Management. 🕒 . 100% Remote | Must work PST hours. 🏥 . Medicare Advantage | Inpatient & Post-Acute Focus. We’re looking for an experienced . Medical Director (Utilization Management). to help lead clinical integrity and medical necessity decision-making across inpatient and post-acute care services for . Medicare Advantage members. .. Reporting directly to the . Chief Medical Officer. , this physician leader will play a key role in ensuring . appropriate, evidence-based, and compliant care decisions. that support quality outcomes, cost efficiency, and regulatory excellence.. 🔑 . What You’ll Do. Conduct medical necessity reviews for . inpatient admissions, continued stays, and post-acute care. (SNF, IRF, LTACH, Home Health). Apply . MCG / InterQual guidelines. and CMS criteria to utilization decisions. Serve as physician reviewer for . complex and escalated UM cases. Participate in . peer-to-peer discussions. with attending physicians. Partner with UM and Care Management teams to ensure consistent, cost-effective care. Support . CMS compliance, NCQA standards, audits, and delegated oversight. Identify utilization trends and contribute to . quality improvement initiatives. Assist in developing . medical policies and UM protocols. Maintain accurate clinical documentation per regulatory standards. 🎯 . You’ll Be Successful If You Have. Deep expertise using . MCG guidelines. in clinical decision-making. Strong background in . inpatient and post-acute utilization review. Experience working in . managed care or health plan environments. Excellent analytical, documentation, and negotiation skills. Strong physician-to-physician communication abilities. Collaborative mindset and comfort working in . matrix organizations. High attention to detail and commitment to confidentiality and compliance. 🩺 . What You Bring. MD or DO. , licensed and in good standing. 5+ years of clinical experience. , including . 3+ years in UM or medical leadership. Strong knowledge of . Medicare Advantage regulations & CMS coverage criteria. Experience with . MCG or InterQual. Advanced computer skills (MS Office, medical management systems). ⭐ . Preferred. MPH, MBA, or MHA. ABQAURP Certification