Medical Director - Utilization Management & Appeals

REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS$180/hour | W-2 Contract | Monday–Friday | 100% Remote | Potential ExtensionThe Jacobson Group is seeking a Medical Director to support a health plan's Utilization Management and Appeals programs. This is an excellent opportunity for a physician who enjoys clinical decision-making, medical necessity review, and appeals oversight without the responsibility of managing a staff.You'll work across Medicare Advantage, Commercial, and ACA lines of business and partner with the Chief Medical Officer and UM team to ensure appropriate, high-quality, and medically necessary care.WHY CONSIDER THIS OPPORTUNITY?$180/hour W-2100% remoteMonday–Friday, 8:00 AM–5:00 PMNo direct staff managementWork with Medicare Advantage, Commercial & ACA populationsFocus on clinical judgment, medical necessity and appealsContract currently expected through the end of the year, with potential for extensionMedical, dental and vision benefits available401(k) retirement savings planWHAT YOU'LL DOSupport the CMO with oversight of the appropriateness, availability and medical necessity of careParticipate in clinical decision-making for the Utilization Management programReview cases and render determinations when services do not meet medical necessity criteria or are considered experimental, investigational or unprovenReview approximately 10–14 appeals per dayComplete expedited appeals the same day and standard appeals within two daysProvide final physician sign-off on adverse determinationsApply clinical judgment across Medicare Advantage, Commercial and ACACollaborate with UM, clinical and operational teams to support regulatory and quality requirementsWHAT WE'RE LOOKING FORMD or DOActive, unrestricted Wisconsin medical license OR willingness/ability to obtain Wisconsin licensure3+ years of Utilization Management experienceExperience with medical necessity review and adverse determinationsExperience with Medicare Advantage, Commercial and/or ACAAppeals experience strongly preferredStrong clinical judgment and ability to make independent determinationsComfortable working remotely and managing a high-volume caseloadA GREAT FIT FOR PHYSICIANS WITH EXPERIENCE AS:Medical Director | Physician Advisor | Utilization Management Medical Director | Appeals Medical Director | UM Physician | Health Plan Medical DirectorTechnology: QuickBase, Microsoft Teams and Microsoft OfficeCOMPENSATION & BENEFITS$180/hour W-2Benefits include:Medical insuranceDental insuranceVision insurance401(k) retirement savings planInterested?Contact Karrie Ruch with The Jacobson Group at +1 (312) 884-0418 or kruch@jacobsongroup.comRefer a Colleague:Do you know someone who would be interested in this project? Submit your referral directly by emailing the Jacobson contact listed above or submitting them through this form. If your referral is hired for a contract assignment and meets all other eligibility criteria, you will receive a referral bonus!Equal Opportunity Employer:The Jacobson Group is committed to fostering an inclusive and equitable workplace that reflects the diverse communities we serve. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status or any other protected characteristic as defined by applicable law. We believe that diversity of thought, background and experience strengthens our team and drives innovation. All employment decisions are based on qualifications, merit and business needs.If you require a reasonable accommodation to complete the application process or participate in an interview, please contact us at HR@jacobsononline.com or +1 (800) 466-1578 to make a request.