Associate Medical Director-Health Services UM & Virtual Support

Job description

Accountabilities Make medical management and utilization management decisions within the assigned scope of authority, consistent with applicable state regulations, delegation requirements, appeals processes, and client expectations. Provide medical decision-making support for rehabilitation services and other assigned service lines, including physical therapy, occupational therapy, speech therapy, athletic training, chiropractic, and acupuncture. Conduct medical necessity reviews and utilization reviews while maintaining appropriate quality, accuracy, productivity, and turnaround times. Support delegated appeals processes through clinical review and medical decision-making. Provide clinical guidance and support to Clinical Quality and Evaluation team members for training, auditing, quality initiatives, and other assigned projects. Participate in utilization management activities and file reviews as needed to address workload, turnaround-time requirements, staffing needs, planned absences, and other operational priorities. Provide virtual telehealth medical consultation and clinical support for designated virtual healthcare programs. Collaborate with senior medical directors, the Chief Health Services Officer, and other clinical and operational leaders on medical management activities and special initiatives. Serve as backup support for medical necessity review activities and other medical director functions when required. Contribute to the development and application of clinical policies, guidelines, quality standards, and medical necessity criteria. Attend clinical committee meetings and contribute to clinical quality management and organizational healthcare initiatives. Apply for, obtain, and maintain medical licenses in additional states as required for the role. Foster effective teamwork, communication, and organizational efficiency across clinical and operational teams. Maintain compliance with all applicable organizational policies, procedures, standards, regulatory requirements, and confidentiality expectations. Perform additional duties and special projects as assigned. Requirements Graduate of an accredited medical college in the United States. Board certification is required. Minimum of 5 years of clinical practice experience. Current, unrestricted medical or osteopathic license in the United States, with the ability and willingness to obtain and maintain additional state medical licenses as required. All clinical credentials must remain active and in good standing with the applicable state medical boards. Demonstrated experience in utilization management and medical necessity review. Experience conducting provider discussions related to utilization management and medical necessity decisions. Experience in clinical quality assurance and/or quality management. Strong knowledge of musculoskeletal medicine and/or physical therapy. Ability to make sound clinical decisions and provide guidance to staff involved in credentialing, medical necessity review, utilization management, quality assurance, quality improvement, and medical necessity verification. Ability to research clinical information, validate relevant evidence, and apply findings appropriately to medical and operational decisions. Ability to provide telehealth medical consultation and clinical support for virtual healthcare programs. Ability to understand, develop, and apply clinical policies and guidelines supporting clinical staff and healthcare decision-making. Experience as a medical director within a full-service health plan or insurance organization is preferred. Familiarity with complementary healthcare services is preferred. Strong computer skills and confidence working with technology-enabled healthcare and remote-work environments. Excellent analytical, problem-solving, organizational, and decision-making skills. Strong listening, interpersonal, and written and verbal communication skills. Demonstrated ability to establish positive, respectful, and cooperative relationships with internal and external stakeholders. Ability to organize, prioritize, multitask, and manage time effectively in a changing environment with frequent interruptions. Strong attention to accuracy and productivity while managing competing priorities. Ability to handle confidential information with discretion and maintain strict confidentiality. Primarily sedentary work requiring the ability to sit for extended periods. Ability to communicate effectively through verbal and written channels and use standard office technology, including telephones, keyboards, computers, and mice. Ability to work effectively from a designated home office environment with reliable internet connectivity. Ability to lift and carry objects weighing up to 10 pounds. Benefits Part-time hourly salary range of $90–$110, with actual compensation based on qualifications, education, skills, experience, and internal equity. Fully remote work-from-home environment within the United States. Remote onboarding and training with company-provided technology equipment. Opportunity to contribute to utilization management, clinical quality, telehealth, and healthcare improvement initiatives. Collaboration with senior medical leadership and multidisciplinary clinical and operational teams. Opportunity to support clinical policy development and quality improvement programs. Professional exposure across rehabilitation, complementary health services, utilization management, and virtual healthcare. Flexible remote environment designed to support clinical and operational collaboration. Opportunities to contribute to special projects, clinical committees, training, auditing, and broader healthcare initiatives. Support for obtaining and maintaining additional state medical licenses when required for the position. Meaningful opportunity to influence the quality, efficiency, and effectiveness of healthcare delivery through physician-led clinical decision-making. 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. #LI-CL1 This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for an Associate Medical Director-Health Services UM & Virtual Support based in the United States. This role provides physician-led clinical oversight across utilization management, medical necessity review, quality management, and virtual healthcare support.You will make informed medical decisions across rehabilitation and complementary health service lines, including physical therapy, occupational therapy, speech therapy, chiropractic, and acupuncture.Working alongside senior medical leadership and clinical and operational teams, you will help ensure decisions are accurate, consistent, timely, and aligned with regulatory and client requirements.The position combines clinical expertise with utilization management, appeals support, quality assurance, policy development, and telehealth consultation.You will also contribute to training, auditing, clinical committees, and special projects that strengthen the quality and efficiency of healthcare delivery.This is a collaborative opportunity for an experienced physician who can apply sound clinical judgment while navigating complex healthcare systems and evolving operational priorities.The role is primarily remote and offers meaningful opportunities to influence both individual medical decisions and broader clinical quality initiatives.