UM Medical Director - Surgical Specialty - Remote

Atlanta, Georgia (United States) Overview In this Medical Director role, you apply clinical knowledge to guide utilization management and benefit coverage decisions. You will collaborate with Enterprise Clinical Services leadership to shape clinical and operational processes that improve care quality and cost effectiveness. You'll review requests, communicate decisions to providers, and ensure timely, evidence-based determinations. This position offers remote work within the U.S. and the opportunity to impact care delivery at scale. You'll join a mission-driven team focused on equitable, data-informed health outcomes. Compensation / Benefits comprehensive benefits package incentive and recognition programs equity stock purchase 401k contribution telecommuter policy adherence career development opportunities Responsibilities Conduct coverage reviews aligned with member benefits and policy frameworks and render determinations Document review findings and outcomes per policy, regulatory, and accreditation standards Engage in peer-to-peer discussions with requesting providers as needed Interpret benefit language and policies during clinical coverage reviews Participate in daily clinical rounds as requested Collaborate with network and non-network providers to support accurate determinations and provider education Coordinate with internal partners and participate in holiday and call coverage rotations Key requirements MD or DO Board certification in any surgical specialty (ABMS or AOA) Active unrestricted medical license with ability to obtain additional state licenses 5+ years of clinical practice post-residency Solid understanding of Evidence Based Medicine (EBM) Proficiency with MS Word, Outlook, and Excel Ability to participate in rotational holiday and call coverage excellent oral and written communication facilitation and collaborative teamwork analytical and problem-solving abilities evidence-based medicine (EBM) data analysis and interpretation clinical coverage review