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Medical Director Utilization Management Jobs (NOW HIRING)

St. Cloud Orthopedics

The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over ...

Tnafp

$248K - $373K/yr

The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination ...

Sustainable World, Inc.

$248K - $373K/yr

The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination ...

Colorado Psychiatric

$248K - $373K/yr

The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination ...

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Medical Director Utilization Management information

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$13K

$232.4K

$357K

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

As of Sep 13, 2026, the average yearly pay for medical director utilization management in the United States is $232,369.00, according to ZipRecruiter salary data. Most workers in this role earn between $198,000.00 and $284,500.00 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.

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

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

Medical Director Utilization Management jobs near you
Infographic showing various Medical Director Utilization Management job openings in the United States as of September 2026, with employment types broken down into 1% As Needed, 77% Full Time, 15% Part Time, and 7% Contract. Highlights an 91% Physical, 1% Hybrid, and 8% Remote job distribution, with an average salary of $232,369 per year, or $111.7 per hour.

Medical Director, Utilization Management Physician - Optum - Remote

On-site

St. Cloud Orthopedics
Health Care and Social Assistance • 51 - 200 employees
Learn more about St. Cloud Orthopedicsexternal

Other

Medical, Retirement

Posted 14 days ago

Key responsibilities

  • Supports WellMed Medical Management by making utilization management determinations and identifying utilization trends.

  • Participates in case review, medical necessity determination, and development of medical management protocols.

  • Oversees physician compliance with utilization management plans and provides education on medical technologies, review criteria, and policies.

Job description

WellMed, part of the Optum family of businesses, is seeking an internal medicine or family medicine physician to join our Utilization Management team. Optum is a clinician-led care organization that is changing the way clinicians work and live.

The Medical Director for Utilization Management will support WellMed Medical Management, Inc. by making utilization management determinations, identifying utilization trends suggesting possible over or under utilization of services and proactively suggesting improvements to WellMed Medical Management's utilization management program.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Position Highlights & Primary Responsibilities:
  • Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values
  • Remain current and proficient in CMS criteria hierarchy and organizational determination processes
  • Participates in case review and medical necessity determination
  • Maintain proficiency in compliance regulations for both CMS and delegated health plans
  • Conducts post service reviews issued for medical necessity and benefits determination coding
  • Assists in development of medical management, care management, and utilization management protocols
  • Performs all other related duties as assigned
Customer Service:
  • Oversees and ensures physician compliance with UM plan
  • Performs all duties in a professional and responsible manner
  • Responds to physicians and staff in a prompt, pleasant and professional manner
  • Respects physician, patient, and organizational confidentiality
  • Provides quality assurance and education of current medical technologies, review criteria, accepted practice of medicine guidelines, and UM policies and procedures with counsel when criterion are not met
  • Personal and Physician Development
  • Strives to personally expand working knowledge of all aspects of the UM department
  • An active participant in physician meetings
  • Orients new physicians to ensure understanding of company policy and resources available for physician support
  • Assists in the growth and development of subordinates by sharing special knowledge with others and promotes continued education classes
  • Attends continuing education classes to keep abreast of medical advancements and innovative practice guidelines

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors' offices. At WellMed our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:
  • Doctor of Medicine (M.D.), Doctor of Osteopathy (D.O.), or M.B.B.S.
  • Board certification in Family Medicine, Internal Medicine, or emergency medicine
  • An active, unrestricted medical license (any state)
  • 5+ years of post-residency clinic practice experience
  • Proficiency with Microsoft Office applications
Preferred Qualifications:
  • 2+ years of experience in utilization management activities
  • 2+ years of experience with acute admissions
  • 2+ years of experience working in a managed care health plan environment
  • Bilingual (English/Spanish) fluency

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $248,500.00 to $373,000.00 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline:

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

OptumCare is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.

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