Medical Director, Utilization Management

# Medical Director, Utilization Management Managed Care & Clinical Programs Orlando, Florida October 5,  - $275,000 / year

Full Time Application ends:
** November 6, 2026
** Apply Now###

Job Description
*
* Location:

** Orlando, FL (Hybrid)
We are seeking a
** Medical Director, Utilization Management
** to lead utilization management, coverage determinations, and clinical appeals for a national health plan, ensuring members receive the right care at the right time. This position is a full-time, direct hire opportunity based in the Orlando, FL area on a hybrid schedule. The role guides a utilization management team across prior authorization, concurrent review, and appeals, and serves as a clinical leader and educator for the department.

This role is well aligned for a physician who is passionate about population health and clinical appropriateness and enjoys combining clinical expertise with leadership. The ideal candidate brings sound clinical judgment, strong regulatory knowledge, and a collaborative approach to working with treating physicians, nursing teams, and plan leadership.

Responsibilities:
* Direct utilization management activities, including prior authorization, concurrent review, and discharge planning
* Render coverage determinations on complex cases using evidence based criteria
* Conduct peer to peer reviews with treating physicians on adverse determinations
* Lead clinical appeals and grievance reviews in accordance with regulatory requirements
* Partner with nursing and care management teams to support appropriate care decisions
* Develop and maintain utilization management policies, guidelines, and coverage criteria
* Ensure compliance with URAC and NCQA accreditation and utilization management standards
* Serve as a clinical educator and resource for the utilization management team
* Monitor utilization management performance metrics and report findings to leadership
*
* Qualifications:

*** MD or DO with an active, unrestricted medical license required; multi-state licensure a plus
* Board certification in a clinical specialty required, with Internal Medicine, Family Medicine, Emergency Medicine, or a specialty with UM relevance preferred
* Minimum of 3 years of managed care, utilization management, or medical director experience
* Experience in a health plan, managed care organization, or insurance environment strongly preferred
* Strong working knowledge of Inter Qual or MCG clinical criteria and URAC and NCQA utilization management standards
* Excellent clinical judgment, written communication, and leadership skills
*
* Schedule:

*** Full-time position
* Hybrid schedule based in the Orlando, FL area, with a combination of onsite and remote days
* Monday through Friday, standard business hours (Eastern Time)
* 40 hours per week
** Salary Range:
** The salary range for this position is approximately $200,000 – $250,000 annually ($96.15 – $120.19 per hour), based on experience and qualifications.
** Interview Process:
** Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

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- ** Equal Opportunity

Employer:

** TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.