Medical Director – Utilization Management, Worker's Compensation

Council Capital

. Serve as the primary physician resource for utilization management decision-making, escalations, and complex case reviews .

Posted 11/4/2026part-timeRemote • United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in Utilization Management and Medical Review, providing clinical oversight for medical necessity determinations and payer communication strategies. Strong ability to analyze denial trends and implement corrective guidance while collaborating with multidisciplinary teams.

Highest-signal resume keywords

MD Or DO With Active Medical LicenseBoard Certified In Relevant SpecialtyUtilization Management ExperiencePeer-To-Peer Review ExperienceStrong Understanding Of Medical Necessity

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical OversightMedical Necessity DeterminationUtilization ReviewDocumentation Best PracticesDenial Trend Analysis

Soft Skills

Effective CommunicationLeadership Collaboration

Certifications & Qualifications

Board Certification

Industry Keywords

Payer CriteriaManaged Care OrganizationsHealthcare ServicesOutpatient ServicesPost-Acute Care

About the role

Key responsibilities & impact

Serve as the primary physician resource for utilization management decision-making, escalations, and complex case reviews
Provide clinical oversight and guidance for medical necessity determinations
Support concurrent and retrospective review processes as needed
Conduct physician-to-physician reviews with payers to support authorization approvals and overturn denials
Partner with Utilization Management and Revenue Cycle teams to improve payer communication strategies
Identify payer-specific trends and opportunities to improve outcomes
Educate providers on documentation best practices tied to medical necessity and payer criteria
Identify recurring documentation gaps and implement corrective guidance
Support audit preparation and response from a clinical perspective
Partner with Case Management, Utilization Management leadership, Revenue Cycle, Compliance, and Operations
Provide insights and recommendations based on denial trends and utilization data
Participate in leadership discussions related to utilization strategy and risk mitigation

Requirements

What you’ll need

MD or DO with an active, unrestricted medical license
Board Certified in a relevant specialty
Prior experience in Utilization Management, Physician Advisory, Medical Review, or similar role
Strong understanding of medical necessity, payer criteria, and utilization standards
Ability to communicate effectively with both clinicians and non-clinical leaders
Experience working with commercial payers and managed care organizations (preferred)
Prior peer-to-peer review experience with documented success overturning denials (preferred)
Experience in outpatient, post-acute, or multi-site healthcare services environments (preferred)
Exposure to healthcare services organizations operating in growth or PE-backed environments (preferred)

Benefits

Comp & perks

Part-time employment
Remote work arrangement
Opportunity to work with Council Capital and its portfolio companies
Work with the CEO Council, Strategic Healthcare Investors, and internal Value Creation Team