Medical Director – Utilization Management, Worker's Compensation

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🔥 8 minutes ago

🐊 Florida, Tennessee – Remote

🐊 Florida – Remote 🎸 Tennessee – Remote

⏱ Part Time

🔴 Lead

👨‍⚕️ Medical Director

👻 Ghost score 25%

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Council Capital

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2000

🏥 Healthcare

💸 Finance

Healthcare • Finance

Council Capital is a healthcare-focused private investment firm that partners with growth-stage, EBITDA-positive healthcare technology and healthcare services companies. They provide capital plus strategic, operational and network support through an experienced investment team, a Value Creation team, and a CEO Council of industry leaders (the CEO Council has personally invested more than $140M in the funds). Council Capital targets mission-driven, often founder-led or bootstrapped businesses with enterprise values typically up to $100M and emphasizes hands-on partnership to accelerate performance and growth.

📋 Description

• 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

• 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

• 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

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