Medical Director – Inpatient Utilization Review

This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Medical Director – Inpatient Utilization Review in the United States.

This role provides expert clinical oversight for inpatient utilization review, ensuring that hospital-based care is medically necessary, guideline-aligned, and cost-effective. The Medical Director works collaboratively with physicians, utilization management teams, and external providers to review complex cases, make well-reasoned clinical determinations, and support high-quality patient outcomes. This position offers the opportunity to impact clinical decision-making in a structured, supportive environment, with clear processes and peer collaboration. Success in this role is measured by accuracy, consistency, and positive engagement with both internal teams and external stakeholders. Ideal candidates are experienced hospitalists, intensivists, emergency physicians, or physicians with prior utilization review experience who enjoy structured clinical analysis. This is a full-time, remote role with occasional travel and rotational weekend coverage.

Accountabilities:

Conduct thorough, compliant inpatient medical necessity reviews for diverse patient populations.
Provide clear, well-documented clinical determinations and communicate effectively with internal teams and external providers.
Collaborate with physicians, utilization management, and care teams to ensure alignment with clinical guidelines and regulatory requirements.
Participate in rotational weekend and holiday coverage, maintaining consistency and accuracy of reviews.
Support continuous process improvement and adoption of evolving utilization management practices and clinical tools.
Engage with payors and other stakeholders to discuss cases, gather information, and resolve clinical questions.
Contribute to educational initiatives and team learning to strengthen clinical expertise across the organization.

Requirements:

MD or DO degree with current, unrestricted medical license; willingness to obtain additional licenses as needed.
Board Certification in an approved ABMS or AOABPS medical specialty.
5+ years of post-residency clinical experience, ideally with inpatient exposure (hospitalist, ED, ICU, or hospital-based FP/IM).
Strong analytical, decision-making, and documentation skills.
Effective verbal and written communication, capable of articulating complex clinical information clearly.
Prior experience in utilization management, inpatient review, or payor operations preferred.
Familiarity with MCG® or InterQual® guidelines, Medicare Advantage, Managed Medicaid, or commercial insurance models preferred.
Ability to work collaboratively in structured team environments and adapt to workflow or regulatory changes.

Benefits:

Competitive salary range of $223,800 – $313,100 per year with eligibility for bonus incentives.
Comprehensive health benefits including medical, dental, vision, life, short-term and long-term disability coverage.
401(k) retirement plan with employer contributions.
Paid time off, company and personal holidays, and paid parental/caregiver leave.
Opportunities for professional development, continuing education, and team learning initiatives.
Remote work flexibility with occasional travel for training or meetings.
Structured work schedule with predictable hours and rotational weekend coverage.

How Jobgether works:

We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team.

We appreciate your interest and wish you the best!

Why Apply Through Jobgether?

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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Medical Director – Inpatient Utilization Review

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