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Medical Director Utilization Management Jobs in Florida

Phsorg

$65K - $111K/yr

Consults with PHP medical directors and refers for medical director decisions on cases not meeting ... utilization management or experience working in long term care services * Knowledge of all state ...

Memorial Healthcare

The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management (UR) and related activities. The Medical ...

UHS

DIR - UTILIZATION REVIEW / MGMT

Jacksonville, FL · On-site

Responsibilities The Utilization Review Director is responsible for directing and overseeing the Utilization Management Department. This includes the implementation of case management scenarios ...

Sunshine State Health Plan

Medical Director

Miami, FL · On-site +1

$236K - $449K/yr

Provides medical leadership of all for utilization management, cost containment, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...

Posted today

Sunshine State Health Plan

Medical Director

Pompano Beach, FL · On-site +1

$236K - $449K/yr

Provides medical leadership of all for utilization management, cost containment, and medical ... Assists Chief Medical Director in planning and establishing goals and policies to improve quality ...

Posted today

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All JobsMedical Utilization Management JobsMedical Director Utilization Management JobsMedical Director Utilization Management Jobs in Florida

Medical Director Utilization Management information

See Florida salary details

$9.7K

$173.6K

$266.8K

How much do medical director utilization management jobs pay per year?

As of Aug 30, 2026, the average yearly pay for medical director utilization management in Florida is $173,647.00, according to ZipRecruiter salary data. Most workers in this role earn between $148,000.00 and $212,600.00 per year, depending on experience, location, and employer.

What is a medical director utilization management?

A Medical Director of Utilization Management is a physician who oversees and ensures the appropriate use of medical resources within a healthcare organization or insurance company. Their responsibilities include reviewing clinical cases, developing utilization review policies, and working with healthcare providers to ensure that treatment plans are medically necessary and cost-effective. They play a key role in balancing patient care quality with regulatory and financial considerations, helping to improve healthcare outcomes and system efficiency.

What are the key skills and qualifications needed to thrive as a medical director utilization management?

To thrive as a Medical Director Utilization Management, you need a medical degree (MD or DO), board certification, and extensive clinical experience, often in internal medicine or a related specialty. Familiarity with utilization review processes, case management software, and regulatory frameworks such as CMS guidelines is essential. Strong leadership, analytical thinking, and effective communication skills are crucial for guiding teams and collaborating with diverse stakeholders. These competencies ensure appropriate resource utilization, regulatory compliance, and high-quality patient care within healthcare organizations.

How does a medical director utilization management typically collaborate with clinical teams and insurance providers?

A Medical Director in Utilization Management frequently works at the intersection of healthcare providers, clinical teams, and insurance companies. Their role involves reviewing clinical cases, making coverage determinations, and consulting with physicians to ensure that medical treatments are both necessary and cost-effective. Collaboration often includes participating in interdisciplinary meetings, providing guidance on complex cases, and communicating policy updates or clinical guidelines. This ensures that patient care decisions align with best practices, regulatory requirements, and payer policies.

What is the difference between Medical Director Utilization Management vs Medical Director Case Management?

AspectMedical Director Utilization ManagementMedical Director Case Management
CredentialsMedical degree, medical license, possibly board certificationMedical degree, medical license, possibly board certification
Work EnvironmentUtilization review departments, insurance companies, healthcare organizationsCase management teams, hospitals, healthcare providers
Employer & IndustryInsurance companies, managed care organizationsHospitals, healthcare systems, community health agencies
Primary FocusReviewing medical necessity and approving servicesCoordinating patient care and discharge planning

Both roles require medical credentials and involve improving patient care, but Medical Director Utilization Management primarily focuses on reviewing and approving healthcare services for insurance purposes, while Medical Director Case Management emphasizes coordinating ongoing patient care and discharge planning within healthcare settings.

What are popular job titles related to Medical Director Utilization Management jobs in Florida?

For Medical Director Utilization Management jobs in Florida, the most frequently searched job titles are:

What job categories do people searching Medical Director Utilization Management jobs in Florida look for?

The top searched job categories for Medical Director Utilization Management jobs in Florida are:

What cities in Florida are hiring for Medical Director Utilization Management jobs?

Cities in Florida with the most Medical Director Utilization Management job openings:

Medical Director Utilization Management jobs near you
Infographic showing various Medical Director Utilization Management job openings in Florida as of August 2026, with employment types broken down into 100% Full Time. Highlights an 50% In-person, and 50% Remote job distribution, with an average salary of $173,647 per year, or $83.5 per hour.

Medical Director Utilization Management Oncology

Starling Oncology

Miami, FL • Remote

$275K - $325K/yr

Full-time

Re-posted 7 days ago

Job description

Starling Oncology (NASDAQ: STLN) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. Formerly known as The Oncology Institute, Starling Oncology offers cutting-edge, evidence-based cancer care to a population of approximately 2.1 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With more than 400 employed and network clinicians and over 100 clinics and network locations of care across five states and growing, Starling Oncology is changing oncology for the better. For more information, visit www.starlingoncology.com.

Utilization Management Medical Director Oncology

Work Location: REMOTE (work from home)

California         Nevada               Arizona               Oregon                Florida

The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with a focus on direct utilization management for case review and clinical decision making.  

In this collaborative role, you will work with physicians, clinical teams and operational leaders to support evidence-based high quality and cost-effective care delivery across the network. You will also contribute to cross-functional initiatives, data-driven insights, and oversight of utilization management policies to optimize patient outcomes. 

  Key Responsibilities: 

  • Conduct medical reviews and make independent clinical decisions of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices. 
  • Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices. 
  • Provide clinical guidance and recommendations that balance quality, outcomes, and cost-effectiveness.  
  • Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage. 
  • Evaluate clinical and utilization data to identify trends, variations in care, and opportunities for improvement 
  • Partner with clinical and operational teams to support value-based care. 
  • Ensure compliance with organizational policies, regulatory standards, and payer requirements in all clinical decisions. 
  • Participate in the development and continuous improvement of utilization management protocols and criteria specific to oncology. 

Qualifications: 

  • Medical degree (MD or DO) 
  • Board Certification in Oncology. 
  • Minimum of 5 years of clinical experience in oncology. 
  • 2+ years of Utilization Management experience 
  • Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans. 
  • Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies. 
  • Excellent analytical skills and the ability to evaluate complex clinical data. 
  • Ability to work independently and make evidence-based decisions in a collaborative, multidisciplinary setting. 
  • Excellent communication skills to engage effectively with healthcare providers, payers, and patients. 

If you're interested in learning more, but not ready to apply, please reach out to our team to set-up a call at your convenience. Physiciancareers@theoncologyinstitute.com

Ready to apply? Please complete the simple application and our team will reach out to you quickly.

The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role. 

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$275,000—$325,000 USD

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