Medical Director - Utilization Management & Appeals

REMOTE MEDICAL DIRECTOR – UTILIZATION MANAGEMENT & APPEALS$180/hour | W-2 Contract | Monday–Friday | 100% Remote | Potential Extension The 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% remote Monday–Friday, 8:00 AM–5:00 PMNo direct staff management Work with Medicare Advantage, Commercial & ACA populations Focus on clinical judgment, medical necessity and appeals Contract currently expected through the end of the year, with potential for extension Medical, dental and vision benefits available 401(k) retirement savings planWHAT YOU'LL DOSupport the CMO with oversight of the appropriateness, availability and medical necessity of care Participate in clinical decision-making for the Utilization Management program Review cases and render determinations when services do not meet medical necessity criteria or are considered experimental, investigational or unproven Review approximately 10–14 appeals per day Complete expedited appeals the same day and standard appeals within two days Provide final physician sign-off on adverse determinations Apply 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 licensure 3+ years of Utilization Management experience Experience with medical necessity review and adverse determinations Experience with Medicare Advantage, Commercial and/or ACAAppeals experience strongly preferred Strong clinical judgment and ability to make independent determinations Comfortable 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 Director Technology: Quick Base, Microsoft Teams and Microsoft OfficeCOMPENSATION & BENEFITS$180/hour W-2