Medical Director – Utilization Management

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🔥 1 minute ago

🏖️ New Jersey – Remote

🏖️ New Jersey – Remote

⏳ Contract/Temporary

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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Bickham Services Unlimited, LLC

WebsiteLinkedInAll Job Openings

1 - 10 employees

Founded 2017

🏗️ Construction

💼 Consulting

📦 Logistics

Construction • Consulting • Logistics

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.

📋 Description

• Conduct timely utilization reviews and medical necessity determinations for inpatient admissions and continued stays • Review post-acute care services, including SNF, IRF, LTACH, and home health • Evaluate acute and post-acute services using MCG, InterQual, CMS criteria, commercial medical policies, and member benefit plans • Apply regulatory and coverage standards based on the member's line of business • Serve as a physician reviewer for escalated, complex, or potentially adverse utilization management cases • Participate in peer-to-peer discussions with treating and attending physicians • Collaborate with utilization management and care management teams to support consistent and cost-effective care • Identify utilization trends and support initiatives to reduce avoidable admissions and readmissions • Provide clinical input on medical policies, clinical guidelines, and utilization management protocols • Support regulatory compliance, audit readiness, accreditation, and delegated oversight activities • Contribute to quality improvement initiatives involving utilization patterns, readmissions, and care transitions • Ensure reviews and determinations are documented according to CMS, NCQA, and applicable state and federal requirements • Participate in utilization management committee meetings and represent the health plan externally when needed

🎯 Requirements

• Active, unrestricted M.D. or D.O. license in good standing • Current board certification in an appropriate medical specialty • At least 5 years of clinical experience, including at least 3 years of experience in utilization management, physician review, or medical leadership within a managed care or health plan environment • Physician-level utilization management experience supporting Commercial and/or Medicare Advantage populations • Strong experience with inpatient and post-acute care reviews and medical necessity determinations • Knowledge of commercial benefits, coverage requirements, and medical policies • Knowledge of Medicare Advantage and CMS coverage criteria • Experience applying MCG and/or InterQual guidelines • Experience conducting peer-to-peer discussions and communicating complex or adverse determinations • Candidate must reside in or hold applicable licensure for New Jersey • Preferred: Master's degree such as MPH, MBA, or MHA • Preferred: ABQAURP certification • Preferred: Experience with quality improvement, regulatory compliance, accreditation, or delegated oversight

🏖️ Benefits

• Potential contract extension • Standard business hours schedule • Remote work arrangement