New York Metro Area (Candidates Must Reside in NY, NJ, or CT)
Full-Time Hybrid Leadership Opportunity
Total Compensation Range: $200k - $225k
We are seeking an experienced Medical Director of Utilization Management to provide clinical leadership within a growing health plan environment serving Medicare and Medicaid populations.
This is an outstanding opportunity for a physician who enjoys collaborating across multidisciplinary teams, driving quality outcomes, ensuring regulatory compliance, and helping members receive the right care at the right time.
What You'll Do
- Serve as the physician leader and clinical resource for Utilization Management operations.
- Conduct medical necessity reviews, peer-to-peer consultations, and appeal determinations.
- Partner with executive leadership to develop and execute medical management initiatives.
- Monitor utilization trends and identify opportunities to improve quality, efficiency, and cost-effectiveness.
- Participate in interdisciplinary care planning discussions to support coordinated member care.
- Ensure compliance with federal, state, accreditation, and contractual requirements.
- Support organizational readiness for audits, surveys, regulatory reviews, and investigations.
- Utilize care management platforms to document clinical reviews and decision-making activities.
- Evaluate utilization data and performance metrics to support strategic planning efforts.
- Contribute to annual departmental goals and provide ongoing progress updates.
- Maintain current knowledge of evolving Medicare, Medicaid, and managed care regulations.
- Collaborate with quality, care management, pharmacy, and operational teams to improve health outcomes.
Required
- Medical Doctor (MD or DO) degree, licensed in NY.
- Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or related specialty.
- 3+ years of experience in health plan medical management.
- Experience supporting Medicare and Medicaid products, including managed care populations.
- Background in utilization management across inpatient and outpatient settings.
- Experience performing appeals reviews and medical necessity determinations.
- Strong knowledge of New York healthcare market dynamics.
What Makes You Successful
- Strategic thinker with strong clinical judgment.
- Excellent communicator who can build relationships across departments.
- Data-driven leader focused on quality improvement and member outcomes.
- Strong understanding of healthcare regulations and managed care operations.
- Passion for improving access, affordability, and quality of care.
SEO Keywords
Medical Director, Utilization Management, Physician Executive, Medical Management, Managed Care, Medicare, Medicaid, MLTC, MAP, MAPD, D-SNP, Appeals Review, Peer-to-Peer Review, Population Health, Value-Based Care, Health Plan Leadership, New York Physician Jobs
Atlas Search is a tri-state area recruitment agency, connecting new graduates, Advanced Practice Providers, Physicians and Nurse Leaders to hospitals, clinics, multi-specialty groups, nursing homes, managed care companies, private practices, and healthcare start-ups.
If you would like to learn more about the opportunities we offer, please submit your CV for consideration here.
