Phoenix, AZ · On-site
$192.86 - $199.75/hr
Medical Director - Surgery, Orthopedics & PM&RRole Summary Are you an accomplished physician leader ... This physician executive role focuses completely on utilization management, medical necessity ...
Phoenix, AZ · On-site
$192.86 - $199.75/hr
Medical Director - Surgery, Orthopedics & PM&RRole Summary Are you an accomplished physician leader ... This physician executive role focuses completely on utilization management, medical necessity ...
Phoenix, AZ · On-site
$150 - $200/hr
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. * Support ...
Phoenix, AZ · On-site
$150 - $200/hr
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. * Support ...
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...
Phoenix, AZ · On-site +1
As the Part-Time Medical Director, you'll provide physician leadership for the organization ... Ensure clinical programs, utilization review activities, and medical management processes align ...
Phoenix, AZ · On-site +1
As the Part-Time Medical Director, you'll provide physician leadership for the organization ... Ensure clinical programs, utilization review activities, and medical management processes align ...
Phoenix, AZ · On-site
$49/hr
Under the direction of the Manager or Director of Care Management, the RN Care Management ... or Utilization Management. Specialized Training: * Trained in Epic, InterQual, Midas, and ...
Phoenix, AZ · On-site
$49/hr
Under the direction of the Manager or Director of Care Management, the RN Care Management ... or Utilization Management. Specialized Training: * Trained in Epic, InterQual, Midas, and ...
Phoenix, AZ · On-site
$49/hr
Under the direction of the Manager or Director of Care Management, the RN Care Management ... or Utilization Management. Specialized Training: * Trained in Epic, InterQual, Midas, and ...
Phoenix, AZ · On-site
$49/hr
Under the direction of the Manager or Director of Care Management, the RN Care Management ... or Utilization Management. Specialized Training: * Trained in Epic, InterQual, Midas, and ...
Phoenix, AZ · On-site
$49/hr
Under the direction of the Manager or Director of Care Management, the RN Care Management ... or Utilization Management. Specialized Training: * Trained in Epic, InterQual, Midas, and ...
Phoenix, AZ · On-site
$49/hr
Under the direction of the Manager or Director of Care Management, the RN Care Management ... or Utilization Management. Specialized Training: * Trained in Epic, InterQual, Midas, and ...
Phoenix, AZ · On-site
$49/hr
Under the direction of the Manager or Director of Care Management, the RN Care Management ... or Utilization Management. Specialized Training: * Trained in Epic, InterQual, Midas, and ...
Phoenix, AZ · On-site
$49/hr
Under the direction of the Manager or Director of Care Management, the RN Care Management ... or Utilization Management. Specialized Training: * Trained in Epic, InterQual, Midas, and ...
Tempe, AZ · Hybrid
$196K - $258K/yr
We're hiring a Senior Director, Escalated Provider Issue Resolution to join our Network & Provider ... Partner with leaders across Claims, Network, Utilization Management, Payment Integrity, Contact ...
Tempe, AZ · Hybrid
$196K - $258K/yr
We're hiring a Senior Director, Escalated Provider Issue Resolution to join our Network & Provider ... Partner with leaders across Claims, Network, Utilization Management, Payment Integrity, Contact ...
Phoenix, AZ · On-site
$192.86 - $199.75/hr
TEEMA Solutions Group is recruiting a Medical Director specializing in Surgery, Orthopedics, or PM ... Utilization Management and appeals. This role is 100% remote, and offers a pay rate ranging from ...
Phoenix, AZ · On-site
$192.86 - $199.75/hr
TEEMA Solutions Group is recruiting a Medical Director specializing in Surgery, Orthopedics, or PM ... Utilization Management and appeals. This role is 100% remote, and offers a pay rate ranging from ...
Phoenix, AZ · Hybrid
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Phoenix, AZ · Hybrid
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Phoenix, AZ · Hybrid
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Phoenix, AZ · Hybrid
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Phoenix, AZ · On-site
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Phoenix, AZ · On-site
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Direct, lead and provide professional oversight for medical management activities related to utilization management, case management, disease management, and quality management activities. Support ...
Phoenix, AZ · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Phoenix, AZ · On-site
$130 - $140/hr
As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...
Three to five years of clinical experience in a direct patient care setting within an acute care hospital required. * Previous experience in case management or utilization management required.
Three to five years of clinical experience in a direct patient care setting within an acute care hospital required. * Previous experience in case management or utilization management required.
Three to five years of clinical experience in a direct patient care setting within an acute care hospital required. * Previous experience in case management or utilization management required.
Three to five years of clinical experience in a direct patient care setting within an acute care hospital required. * Previous experience in case management or utilization management required.
To thrive as a Director Utilization Management, you need a strong background in healthcare administration, case management, and data-driven decision-making, often supported by a clinical degree and several years of management experience. Familiarity with utilization management software, electronic health records (EHRs), and certifications such as CCM or ACM are typically valued. Exceptional leadership, communication, and problem-solving skills distinguish top performers in this role. These competencies are vital for optimizing resource use, ensuring regulatory compliance, and leading teams to meet quality care standards.
A Director of Utilization Management oversees the review and approval of medical services to ensure they are necessary, efficient, and cost-effective. They develop strategies to improve care quality while managing healthcare costs, working closely with providers, payers, and regulatory bodies. Their responsibilities include policy development, compliance with healthcare regulations, and leading a team of utilization review professionals. This role is common in hospitals, insurance companies, and managed care organizations.
A Director Utilization Management generally oversees a team responsible for reviewing patient care to ensure appropriate resource use and compliance with payer requirements. Daily tasks may include analyzing utilization data, developing policy and process improvements, collaborating with clinical and administrative staff, and addressing escalated cases or issues. Directors frequently attend strategy meetings, conduct staff training, and engage with external partners like insurance providers. This role requires balancing administrative oversight with hands-on problem solving to support both cost efficiency and quality patient care.
$192.86 - $199.75/hr
Other
Posted 27 days ago
Are you an accomplished physician leader seeking a prestigious, high-impact executive position with a strong work-life balance? We are actively recruiting a Medical Director specializing in Surgery, Orthopedics, or Physical Medicine & Rehabilitation (PM&R) to provide strategic clinical leadership for TriWest Healthcare Alliance. This physician executive role focuses completely on utilization management, medical necessity reviews, appeals, and clinical governance supporting military members, veterans, and their families. To ensure our leaders maintain sharp, active clinical judgment, this position features a unique dual-practice model: you will dedicate 75% of your time (3 days per week) to TriWest's remote administrative operations and 25% (1 day per week) to your own private practice or locum tenens work. Step into a highly collaborative, tech-forward infrastructure where your specialized medical insights drive macroscopic healthcare transformation.
Duties & ResponsibilitiesClinical Governance & Utilization ReviewCoverage Determinations: Evaluate complex surgical, orthopedic, rehabilitation, and specialty care cases, making accurate coverage and medical necessity determinations based on evidence‑based guidelines.
Appeals & Peer Reviews: Direct robust clinical appeals reviews and conduct collaborative peer‑to‑peer discussions with network providers.
Policy Development: Provide expert clinical guidance to support the development, enhancement, and implementation of healthcare policies and quality oversight structures.
Operational Collaboration: Partner closely with clinical operations, provider relations, quality management, and executive leadership teams to optimize network performance.
Performance Frameworks: Monitor key performance indicators (KPIs) and quality metrics to align workflows with regulatory compliance and accreditation standards.
Dual‑Practice Integration: Actively maintain an outside clinical footprint (1 day per week) in your specialty field to continuously inform your executive decision‑making with modern practice standards.
Other duties as assigned.
Required QualificationsEducational Credentials: Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree.
Board Certification: Current Board Certification in General Surgery, Orthopedic Surgery, or Physical Medicine & Rehabilitation (PM&R).
Licensure: An active, unrestricted state medical license.
Executive Leadership: Previous experience as a Medical Director, Associate Medical Director, Chief Medical Officer, Department Chair, Physician Advisor, or Physician Reviewer.
Managed Care Competency: Strong experience in Utilization Management (UM), Medical Necessity Reviews, Appeals Reviews, and health plan/managed care frameworks.
Geographic Alignment: Must currently reside in an approved TriWest work state.
Practice Split Commitment: Full agreement to maintain a split schedule consisting of 75% (3 days) administrative leadership with TriWest and 25% (1 day) active external clinical practice.
Desired QualificationsGovernment Healthcare Expertise: Prior experience working with TRICARE, the Defense Health Agency (DHA), Department of Defense (DoD), Veterans Affairs (VA), or Military Treatment Facilities (MTFs) is highly preferred.
Network Management: Experience supporting geographically dispersed or multi‑site provider networks.
Multidisciplinary Leadership: Proven track record of guiding multidisciplinary teams and collaborating successfully with nursing and operational executives.
Location and Work TypeWork Setting: 100% Remote (Must reside within an approved state).
Approved Work States: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TND, TX, UT, VA, WA, WI, WY.
Schedule: Structured 40‑hour work week
Hourly Pay Rate: $140.00 – $145.00 per hour.
Perks: This high‑priority "hot" search moves incredibly fast, offering rapid interview turnarounds, substantial career progression pathways, and the unique flexibility to retain your active clinical practice while stepping into elite executive leadership.
If you're interested, please reply to this advertisement or directly email your resume to me at DSalgado@teemagroup.com or by calling/texting (949) 295-5951.
I strive to reply within 48 hours. Looking forward to connecting with you soon. Thank you!
