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Bickham Services Unlimited, LLC logo
Bickham Services Unlimited, LLC

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Medical Director – Utilization Management

Medical DirectorMedical DirectorOtherRemoteLeadTeam 1-10Since 2017H1B No SponsorCompany SiteLinkedIn

Location

Arizona + 4 moreAll locations: Arizona | California | Nevada | Oregon | Texas

Posted

126 days ago

Salary

0

Seniority

Lead

Postgraduate Degree7 yrs expEnglish

Job Description

Medical Director – Utilization Management

Bickham Services Unlimited, LLC

• Provide national medical oversight of all utilization management functions, ensuring alignment with organizational goals and compliance with regulatory and accreditation standards. • Serve as a clinical resource and subject matter expert to utilization management nurses, case managers, and other clinical staff. • Conduct peer reviews and clinical reviews for medical necessity determinations, complex cases, and high-cost claims. • Participate in inter-rater reliability assessments to ensure consistency and accuracy of medical review decisions. • Collaborate with Quality and Risk Adjustment teams on MRA and quality education initiatives to enhance outcomes and compliance. • Partner with leadership to develop and refine utilization management policies, protocols, and criteria based on nationally recognized standards (e.g., MCG, InterQual). • Contribute medical expertise to case management and care coordination processes, ensuring members transition to the appropriate level of care. • Support physician engagement, education, and alignment through clear communication and collaboration with internal and external providers. • Participate in ongoing evaluation and improvement of UM operations, including metrics monitoring and performance review. • Perform other duties as assigned to support clinical and operational initiatives.

Job Requirements

  • Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) degree from an accredited institution required.
  • Current board certification in area of clinical specialty required.
  • Active, unrestricted medical license(s) in one or more of the following states: Nevada, Oregon, California, or Arizona required.
  • Minimum five (5) years of clinical practice experience in primary care required.
  • Minimum two (2) years of medical director experience in a health plan, medical group, or utilization management/medical management role required.
  • Previous experience with Medicare Advantage populations strongly preferred.
  • Experience applying medical management treatment guidelines and nationally recognized criteria such as MCG (preferred), InterQual/McKesson, or equivalent standards required.
  • Experience conducting complex case reviews, peer reviews, and high-cost claim assessments.
  • Advanced training in healthcare administration preferred (e.g., MHA, MBA, MMM, MPH).

Benefits

  • 100% remote work
  • Traveling to NV as needed for required meetings and trainings
  • Potential for a contract extension

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