[Hiring] Medical Director, Utilization Management @Impresiv Health

Role Description

Impresiv Health is seeking an experienced physician leader for a remote Medical Director, Utilization Management (Home Health, Acute & Post-Acute) role. In this position, you will serve as the primary clinical authority for home health authorization requests while supporting acute, post-acute, and outpatient medical necessity reviews for Medicare Advantage populations.

Working closely with the Home Health RN Lead, UM nursing staff, and network providers, you will apply CMS regulations, National/Local Coverage Determinations (NCD/LCD), Milliman Care Guidelines (MCG), and health plan medical policies to drive evidence-based care, ensure appropriate resource utilization, and improve health outcomes.

What You Will Do:

• Clinical Reviews & Determinations:
  • Evaluate outpatient referrals, inpatient direct admissions, and home health authorization requests for medical necessity.
  • Conduct peer-to-peer discussions with treating physicians and providers to discuss clinical coverage criteria, alternative care plans, and complex cases.
  • Apply CMS guidelines, MCG criteria, and health plan medical policies to deliver accurate, timely coverage determinations.
• Clinical Leadership & Nursing Collaboration:
  • Serve as the trusted physician advisor to the Home Health RN Lead and UM nursing staff, offering coaching, clinical mentoring, and complex case guidance.
  • Partner with external Home Health agency leadership to promote documentation standards and alignment with evidence-based care guidelines.
• Policy & Quality Improvement:
  • Contribute to the ongoing refinement of utilization management clinical guidelines, medical policies, and best practices.
  • Collaborate with clinical operations leadership to support quality improvement initiatives and optimize care delivery through tech-enabled solutions.

Qualifications

• MD or DO from an accredited school of medicine.
• Active, unrestricted state medical license (MD/DO) in any US jurisdiction.
• Board Certification in Internal Medicine, Family Medicine, Physical Medicine & Rehabilitation (PM&R), Emergency Medicine, or a closely related specialty.
• Minimum of 5+ years of direct clinical patient care experience.
• At least 1-2+ years of prior experience as a physician reviewer in Utilization Management.
• Direct experience reviewing Home Health medical necessity, as well as acute and post-acute services under Medicare Advantage guidelines.
• Expert command of CMS coverage criteria, NCDs/LCDs, and MCG guidelines.
• Strong peer-to-peer communication, relationship-building, and multi-disciplinary leadership abilities.

Benefits

• Fully Remote | Candidates must be available to work Eastern Time (EST) business hours.
• Part-time hours.