---
title: "Medical Director (Utilization Management) at HJ Staffing – All Job Board"
---

# Medical Director (Utilization Management) at HJ Staffing

Written by

[admin](https://alljobboard.com/author/admin/)

in

- [United States (Remote)](https://maps.google.com/maps?q=United%20States%20%28Remote%29&zoom=14&size=512x512&maptype=roadmap&sensor=false)
- Posted 5 days ago

![HJ Staffing](https://alljobboard.com/wp-content/plugins/wp-job-manager/assets/images/company.png)

 **HJ Staffing**

 **HJ Staffing**  is urgently seeking a **Medical Director of Utilization Management** to join a leading Medicare Advantage Health Plan. This physician leader will play a critical role in ensuring the clinical integrity of inpatient and post-acute care reviews, evaluating medical necessity to support optimal outcomes and regulatory compliance.

**Location:** 100% Remote

**Schedule:** Full-Time, Monday – Friday (Must work **PST hours**)

### **Job Description**

Reporting to the Chief Medical Officer, the Medical Director focuses on Evaluating hospital admissions, continued stays, and post-acute services for Medicare Advantage members. You will guide timely care determinations using CMS regulations and evidence-based practices (MCG/InterQual) while collaborating with care management teams and external providers.

### **What You Will Do**

- **Clinical Review:** Conduct timely medical necessity determinations for inpatient admissions and post-acute settings (SNF, IRF, LTACH, and Home Health).
- **Criteria Application:** Use evidence-based guidelines (**MCG/InterQual**) and CMS criteria to assess the appropriateness of acute care services.
- **Peer-to-Peer:** Lead discussions with attending physicians to clarify clinical documentation and support appropriate levels of care.
- **Complex Case Management:** Serve as the primary physician reviewer for escalated or complex UM cases requiring expert medical judgment.
- **Collaboration:** Partner with utilization and care management teams to ensure consistent, cost-effective care and participate in UM committee meetings.
- **Compliance & Documentation:** Ensure all decisions are documented according to NCQA and CMS requirements; support audit preparedness and delegated oversight.
- **Utilization Trends:** Identify patterns in care and support interventions to reduce unnecessary admissions or extended stays.

### **What You Will Bring**

- **Credentials:** Licensed **M.D. or D.O.** in good standing in your state of residence.
- **Clinical Experience:** Minimum of 5 years of clinical experience.
- **Managed Care Expertise:** At least 3 years in a utilization management or medical leadership role within a managed care or health plan setting.
- **Specialized Knowledge:** Strong experience in inpatient/post-acute case review and deep knowledge of **Medicare Advantage** regulations and CMS coverage criteria.
- **Technical Skills:** Extensive experience with **MCG** guidelines and advanced proficiency in MS Office and medical management software.
- **Education (Preferred):** MPH, MBA, or MHA; Certification by the American Board of Quality Assurance and Utilization Review Physicians (**ABQAURP**).

### **You Will Be Successful If:**

- You are an expert in using data to design and implement clinical programs and population health management.
- You possess strong negotiation skills, particularly in physician-to-physician interactions.
- You thrive in a matrix organization and can mentor staff while making independent, high-stakes decisions.
- You have a meticulous eye for detail and can maintain a reasonable rate of speed in a fast-paced, high-volume environment.
- You are committed to the highest standards of confidentiality and clinical documentation.

Originally posted on Himalayas

**Source:** this listing was published by [Himalayas](https://himalayas.app/). [View the original posting and apply](https://himalayas.app/companies/hj-staffing/jobs/medical-director-utilization-management-5884064178?utm_source=api) — applications are handled there, not on this site.

To apply for this job please visit [himalayas.app](https://himalayas.app/companies/hj-staffing/jobs/medical-director-utilization-management-5884064178?utm_source=api).

## More posts

- ### [Holiday Party Networking: How to Job Hunt Without Making It Awkward](https://alljobboard.com/holiday-party-networking-job-search/)

[November 13, 2026](https://alljobboard.com/holiday-party-networking-job-search/)
- ### [How to Negotiate a Start Date After the Holidays (With Scripts)](https://alljobboard.com/negotiate-start-date-after-holidays/)

[November 13, 2026](https://alljobboard.com/negotiate-start-date-after-holidays/)
- ### [Should You Quit Before or After Your Year-End Bonus?](https://alljobboard.com/quit-before-or-after-year-end-bonus/)

[November 13, 2026](https://alljobboard.com/quit-before-or-after-year-end-bonus/)
- ### [How to List a Seasonal Job on Your Resume (With Examples)](https://alljobboard.com/seasonal-job-on-resume/)

[November 13, 2026](https://alljobboard.com/seasonal-job-on-resume/)

```json
{
    "@context": "http://schema.org/",
    "@type": "JobPosting",
    "datePosted": "2026-11-09T18:19:26+00:00",
    "validThrough": "2027-01-08T23:59:59+00:00",
    "title": "Medical Director (Utilization Management) at HJ Staffing",
    "description": "<p><strong> HJ Staffing </strong> is urgently seeking a <strong>Medical Director of Utilization Management</strong> to join a leading Medicare Advantage Health Plan. This physician leader will play a critical role in ensuring the clinical integrity of inpatient and post-acute care reviews, evaluating medical necessity to support optimal outcomes and regulatory compliance.</p>\n<p><strong>Location:</strong> 100% Remote</p>\n<p><strong>Schedule:</strong> Full-Time, Monday – Friday (Must work <strong>PST hours</strong>)</p>\n<h3><strong>Job Description</strong></h3>\n<p>Reporting to the Chief Medical Officer, the Medical Director focuses on Evaluating hospital admissions, continued stays, and post-acute services for Medicare Advantage members. You will guide timely care determinations using CMS regulations and evidence-based practices (MCG/InterQual) while collaborating with care management teams and external providers.</p>\n<h3><strong>What You Will Do</strong></h3>\n<ul>\n<li> <strong>Clinical Review:</strong> Conduct timely medical necessity determinations for inpatient admissions and post-acute settings (SNF, IRF, LTACH, and Home Health).</li>\n<li> <strong>Criteria Application:</strong> Use evidence-based guidelines (<strong>MCG/InterQual</strong>) and CMS criteria to assess the appropriateness of acute care services.</li>\n<li> <strong>Peer-to-Peer:</strong> Lead discussions with attending physicians to clarify clinical documentation and support appropriate levels of care.</li>\n<li> <strong>Complex Case Management:</strong> Serve as the primary physician reviewer for escalated or complex UM cases requiring expert medical judgment.</li>\n<li> <strong>Collaboration:</strong> Partner with utilization and care management teams to ensure consistent, cost-effective care and participate in UM committee meetings.</li>\n<li> <strong>Compliance &amp; Documentation:</strong> Ensure all decisions are documented according to NCQA and CMS requirements; support audit preparedness and delegated oversight.</li>\n<li> <strong>Utilization Trends:</strong> Identify patterns in care and support interventions to reduce unnecessary admissions or extended stays.</li>\n</ul>\n<h3><strong>What You Will Bring</strong></h3>\n<ul>\n<li> <strong>Credentials:</strong> Licensed <strong>M.D. or D.O.</strong> in good standing in your state of residence.</li>\n<li> <strong>Clinical Experience:</strong> Minimum of 5 years of clinical experience.</li>\n<li> <strong>Managed Care Expertise:</strong> At least 3 years in a utilization management or medical leadership role within a managed care or health plan setting.</li>\n<li> <strong>Specialized Knowledge:</strong> Strong experience in inpatient/post-acute case review and deep knowledge of <strong>Medicare Advantage</strong> regulations and CMS coverage criteria.</li>\n<li> <strong>Technical Skills:</strong> Extensive experience with <strong>MCG</strong> guidelines and advanced proficiency in MS Office and medical management software.</li>\n<li> <strong>Education (Preferred):</strong> MPH, MBA, or MHA; Certification by the American Board of Quality Assurance and Utilization Review Physicians (<strong>ABQAURP</strong>).</li>\n</ul>\n<h3><strong>You Will Be Successful If:</strong></h3>\n<ul>\n<li>You are an expert in using data to design and implement clinical programs and population health management.</li>\n<li>You possess strong negotiation skills, particularly in physician-to-physician interactions.</li>\n<li>You thrive in a matrix organization and can mentor staff while making independent, high-stakes decisions.</li>\n<li>You have a meticulous eye for detail and can maintain a reasonable rate of speed in a fast-paced, high-volume environment.</li>\n<li>You are committed to the highest standards of confidentiality and clinical documentation.</li>\n</ul>\n<p>Originally posted on Himalayas </p>\n<p class=\"job-source\"><strong>Source:</strong> this listing was published by <a href=\"https://himalayas.app/\" rel=\"dofollow\">Himalayas</a>. <a href=\"https://himalayas.app/companies/hj-staffing/jobs/medical-director-utilization-management-5884064178?utm_source=api\" rel=\"dofollow\">View the original posting and apply</a> &mdash; applications are handled there, not on this site.</p>\n",
    "hiringOrganization": {
        "@type": "Organization",
        "name": "HJ Staffing"
    },
    "identifier": {
        "@type": "PropertyValue",
        "name": "HJ Staffing",
        "value": "https://alljobboard.com/job/medical-director-utilization-management-at-hj-staffing/"
    },
    "jobLocation": {
        "@type": "Place",
        "address": "United States"
    },
    "jobLocationType": "TELECOMMUTE",
    "directApply": true
}
```