Medical Director

Job Description Summary ‎ The Utilization Management (UM) Medical Director provides clinical leadership for the UM program, ensuring members receive appropriate, high-quality care. You will oversee review guidelines, collaborate with internal teams and external partners, and drive compliance with regulatory and accreditation standards. ‎ How will you make an impact & Requirements ‎ **This is a remote position; however, candidates located in CA, NV, or AZ are preferred.** CareMore Health is a physician-founded and physician-led organization that has been transforming care delivery since 1992. With 25 clinics, 65,000 members and partnerships with 30 health plans, we’ve built a reputation for delivering exceptional, integrated healthcare experiences to Medicare, Medicaid, and group or private plan members. Our mission is simple: to improve health outcomes by delivering a transformative and integrated healthcare experience impacting physical, social and emotional well-being. Cultivating life-long relationships with patients, grounded in compassion and unwavering dedication to excellence in care, we’ve built care teams around our patients’ needs — including doctors, nurse practitioners, case managers, community health workers, social workers, pharmacists and specialists, all working together to produce the best outcomes possible. This people-first, value-based model ensures physicians can practice medicine the way it was meant to be practiced — with time to connect, collaborate, and truly care for patients. Key Responsibilities Lead the development, implementation, and periodic review of UM policies and clinical criteria Provide physician oversight for concurrent and retrospective review activities Approve and interpret clinical guidelines, pathways, and criteria for admission, continued stay, and discharge Serve as the primary clinical liaison with payers, providers, and regulatory bodies Mentor and educate UM nurses, physician reviewers, and other staff on best practices Analyze utilization data and quality metrics to identify trends and areas for improvement Participate in appeals and peer-to-peer discussions to resolve clinical disputes Maintain compliance with NCQA, URAC, CMS, state regulations, and organizational standards Participation in the physician call rotation, requiring coverage for one full weekend (Saturday and Sunday) approximately every four to five weeks. As compensation, one half-day of flex time (AM or PM) is provided during the following work week Qualifications Medical degree (MD or DO) from an accredited institution Active, unrestricted medical license in [State/Region] Board certification in an acute-care specialty (e.g., Internal Medicine, Family Medicine, Pediatrics) Minimum of 5 years clinical practice experience, with 2 years in utilization management or managed care Location Preference for candidates in CA, NV, or AZ Requires availability to work standard Pacific Time Zone business hours, regardless of physical location **The posted compensation range represents the national market average. Compensation for roles located in premium or high-cost geographic markets may fall above this range. This position is bonus eligible based on individual and company performance.** ‎ Compensation: $0.00 to $ Beware of fraudulent job postings: While Mosaic Health job advertisements may be found on many sites, our current openings page and its associated Workday account are the only places we accept applications for open roles. If you suspect a job post is fraudulent, please let us know at recruiting@apree.health. Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. Learn More about Mosaic Health Learn More about Millennium Physician Group Learn More about CareMore Health Learn More about Castlight Health Learn More about Vera Whole Health