[Hiring] Medical Director @Council Capital

Role Description

• Utilization Management Leadership
  • Serve as the primary physician resource for UM decision-making, escalations, and complex case reviews
  • Provide clinical oversight and guidance for medical necessity determinations
  • Support concurrent and retrospective review processes as needed
• Peer-to-Peer & Payer Engagement
  • Conduct physician-to-physician reviews with payers to support authorization approvals and overturn denials
  • Partner with UM and Revenue Cycle teams to improve payer communication strategies
  • Identify payer-specific trends and opportunities to improve outcomes
• Clinical Documentation & Education
  • Educate providers on documentation best practices tied to medical necessity and payer criteria
  • Identify recurring documentation gaps and implement corrective guidance
  • Support audit preparation and response from a clinical perspective
• Collaboration & Reporting
  • Partner with Case Management, UM leadership, Revenue Cycle, Compliance, and Operations
  • Provide insights and recommendations based on denial trends and utilization data
  • Participate in leadership discussions related to utilization strategy and risk mitigation

Qualifications

• MD or DO with an active, unrestricted medical license
• Board Certified in a relevant specialty
• Prior experience in Utilization Management, Physician Advisory, Medical Review, or similar role
• Strong understanding of medical necessity, payer criteria, and utilization standards
• Ability to communicate effectively with both clinicians and non-clinical leaders

Requirements

• Experience working with commercial payers and managed care organizations (preferred)
• Prior peer-to-peer review experience with documented success overturning denials (preferred)
• Experience in outpatient, post-acute, or multi-site healthcare services environments (preferred)
• Exposure to healthcare services organizations operating in growth or PE-backed environments (preferred)

Benefits

• Ownership, judgment, and real engagement are required for this role