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Medical Director Utilization Management Jobs in Decatur, GA

Oscar Health

Director, Medical Economics

Atlanta, GA · Remote

$178K - $234K/yr

You will manage your team to contribute analyses, reports, and dashboards to the medical economics ... Lead the proactive identification, sizing, and root-cause analysis of medical cost and utilization ...

Oscar Health

Director, Medical Economics

Atlanta, GA · Remote

$178K - $234K/yr

You will manage your team to contribute analyses, reports, and dashboards to the medical economics ... Lead the proactive identification, sizing, and root-cause analysis of medical cost and utilization ...

Apply Early

Devereux

Medical Director

Kennesaw, GA · On-site

Being a Medical Director at Devereux has its Advantages You will work with other dedicated ... managing psychiatry team, implementation of clinical best practices and program development.

Oscar Health

Director, Medical Economics

Atlanta, GA · On-site

$178K - $234K/yr

You will manage your team to contribute analyses, reports, and dashboards to the medical economics ... Lead the proactive identification, sizing, and root-cause analysis of medical cost and utilization ...

CVS Health

Center Medical Director

Stone Mountain, GA

$174K - $374K/yr

Center Medical Director Company: Oak Street Health Role Description: The purpose of the Center ... Provider Management * Help coordinate and lead the onboarding of new providers at the center.

AccentCare, Inc.

Hospice Medical Director

Alpharetta, GA · On-site

Hospice Medical Director Location: Atlanta, GA Position Type: Part Time Coverage Area: Greater ... management * Collaborate with and mentor attending and community physicians, offering clinical ...

Apply Early

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All JobsMedical Director Utilization Management JobsMedical Director Utilization Management Jobs in Decatur, GA

Medical Director Utilization Management information

See Decatur, GA salary details

$12.7K

$226.9K

$348.6K

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

As of Jul 1, 2026, the average yearly pay for medical director utilization management in Decatur, GA is $226,869.00, according to ZipRecruiter salary data. Most workers in this role earn between $193,300.00 and $277,800.00 per year, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive as a Medical Director Utilization Management, and why are they important?

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 in 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 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 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 Decatur, GA? For Medical Director Utilization Management jobs in Decatur, GA, the most frequently searched job titles are:
What job categories do people searching Medical Director Utilization Management jobs in Decatur, GA look for? The top searched job categories for Medical Director Utilization Management jobs in Decatur, GA are:
What cities near Decatur, GA are hiring for Medical Director Utilization Management jobs? Cities near Decatur, GA with the most Medical Director Utilization Management job openings:
Medical Director Utilization Management jobs near you
Director, Medical Economics

Director, Medical Economics

Oscar Health

Atlanta, GA • Remote

$178K - $234K/yr

Other

Medical, PTO

Posted 5 days ago

Oscar Health rating

6.9

Company rating: 6.9 out of 10

Based on 6 frontline employees who took The Breakroom Quiz

237th of 277 rated insurance

Job description

Hi, we're Oscar. We're hiring a Director, Medical Economics to join our Actuarial team.

Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves-one that behaves like a doctor in the family.

About the role:

The Director, Medical Economics, plays an instrumental role in Oscar's medical economics operating model, serving as a dedicated, proactive financial and analytic partner to a Market Vice President. You will be the point person accountable for supporting trend management and achieving market affordability targets. Rather than just tracking data, you will identify, size, and diagnose medical cost and utilization drivers, translating data into action. You will work as a strategic "quarterback," to triage deep-dive analytics to centralized analytic teams such as network performance, forecasting, and data science when appropriate, while maintaining deep understanding and ownership over your markets' context, goals, and results. You will manage your team to contribute analyses, reports, and dashboards to the medical economics tooling suite, building to meet market level needs in a way that is standardized, repeatable and re-usable across markets.

You will report to the Senior Director, Medical Cost Analytics.

Work Location: This is a remote position, open to candidates who reside in: Atlanta, GA. You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote

Pay Transparency: The base pay for this role is: $178,848 - $234,738 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, company equity grants and annual performance bonuses.

Responsibilities:

  • Trend Management Accountability & Partnership: Partner with regional Market teams, regional actuaries, and market medical officers to co-lead regional trend management and drive total cost of care reduction strategies.
  • Proactive Opportunity Identification: Lead the proactive identification, sizing, and root-cause analysis of medical cost and utilization anomalies ("flares") and identification of affordability opportunities within assigned regions.
  • Executive Communication: Present comprehensive, executive-ready analytics and materials
  • Team Leadership: Mentor analysts in developing both analytic expertise and "soft skills," specifically regarding business writing, data visualization, and partner influence.
  • Analytic Quarterbacking: Act as a primary gateway and triage point for your market team's medical economics requests, effectively routing complex requests to centralized analytic teams such as network performance, forecasting, and data science when appropriate, while managing end-to-end follow-up with market leadership.
  • Affordability Integration: Connect local market programs and emerging cost flares into Oscar's centralized affordability framework and governance programs.
  • Playbook Development: Collaborate with central affordability and local market teams to develop localized trend management strategies.
  • Shared Tooling & Innovation: Contribute to the department's core tooling strategy by building analytics tailored to specific market needs with an eye toward scaling them into national solutions via our internal tooling program. Develop best practices in analytics, automation, and documentation, contributing to department programs around innovation, and tooling improvements. Improve adoption of generative AI tools to improve team effectiveness.
  • Enablement & Self-Service: Provide support and training to market leadership teams to ensure self-service utilization of medical economics reports & tooling.
  • Cross-Pollination: Promote operational efficiency and shared learning by actively sharing successful tactics, playbooks, and localized analytic tools across different regional markets.
  • Compliance with all applicable laws and regulations
  • Other duties as assigned

Requirements:

  • Bachelor's degree in a STEM field, or 4 years commensurate experience.
  • 10+ years of quantitative analysis in the healthcare industry.
  • Experience with medical economics, corporate strategy, or a related analytics-driven leadership role.
  • Experience with health insurance / payer analytics, with an understanding of medical claims data (e.g., CPT/HCPCS, ICD-10, DRGs) and standard healthcare industry data sources.

Bonus points:

  • Business writing and storytelling skills; ability to simplify complex actuarial concepts for executive audiences.
  • Familiarity with ACA-specific healthcare dynamics and how they impact external financial reporting.
  • Fellow of the Society of Actuaries (SOA), or on the track to become one.

Apply