Medical Director – Utilization Management

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3 days ago

🤠 Texas – Remote

Although this job is listed in Texas, this company may be open to hiring remote in other states.

⏳ Contract/Temporary

🔴 Lead

👨‍⚕️ Medical Director

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Bickham Services Unlimited, LLC

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Recruitment • Government

Bickham Services Unlimited, LLC is a staffing and recruiting firm that provides temporary, temp-to-hire, direct-hire, and contract placements for government, commercial, and private-sector clients. The company specializes in sourcing in-demand professionals across construction, industrial, information technology, administrative, and support roles, and also offers subcontracting and project support services. Bickham Services highlights experience placing talent from entry-level to executive roles, holds multiple minority- and small-business certifications for government contracting, and operates from Houston, Texas.

1 - 10 employees

Founded 2017

🎯 Recruiter

🏛️ Government

📋 Description

• Conduct timely utilization review and medical necessity determinations for inpatient admissions , continued stays , and post-acute care services (SNF, IRF, LTACH, home health) for Medicare Advantage members. • Apply MCG and InterQual guidelines as well as CMS criteria to assess the appropriateness of acute care services. • Serve as the physician reviewer for complex or escalated UM cases requiring clinical judgment. • Collaborate with utilization and care management teams to ensure consistent, cost-effective, and patient-centered care decisions. • Participate in peer-to-peer discussions with attending physicians to clarify documentation and support proper levels of care. • Identify utilization trends and assist in developing interventions to reduce unnecessary admissions or extended stays. • Contribute to the development and implementation of medical policy and UM protocols. • Support CMS regulatory compliance , audit preparedness, and delegated oversight activities. • Participate in UM committee meetings and represent the organization in provider or stakeholder engagements. • Ensure all documentation meets NCQA , CMS , and internal standards.

🎯 Requirements

• Licensed M.D. or D.O. , in good standing in the state of residence. • Minimum 5 years of clinical experience , including 3 years in a utilization management or medical leadership role within a managed care or health plan setting. • Strong knowledge of Medicare Advantage regulations and CMS coverage criteria. • Experience with MCG and InterQual guidelines. • Excellent communication, analytical, and negotiation skills. • Proficiency with MS Office and medical management systems. • Ability to maintain strict confidentiality and adhere to HIPAA and organizational standards. • Preferred: MPH, MBA, or MHA . • Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP).