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: QuickBase, Microsoft Teams and Microsoft OfficeCOMPENSATION & BENEFITS$180/hour W-2Benefits include:
Medical insurance
Dental insurance
Vision insurance 401(k) retirement savings plan
Interested?
Contact Karrie Ruch with The Jacobson Group at +1 (312) 884-0418 or Refer 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 or +1 (800) 466-1578 to make a request.
