Medical Director - OP Medicare

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Medical Director - OP Medicare based in United States.

This is a remote physician leadership role focused on complex outpatient utilization management for Medicare populations.
You will apply clinical expertise and medical judgment to evaluate authorization requests, medical necessity, level of care, and site-of-service decisions.
The role combines independent clinical review with collaboration across physicians, care management, analytics, and other healthcare teams.
You will use clinical guidelines, CMS requirements, Medicare policies, and internal standards to support consistent, evidence-based determinations.
Beyond case review, the position offers opportunities to contribute to care management, appeals, clinical documentation, and population health initiatives.
The environment emphasizes sound judgment, regulatory compliance, operational excellence, and continuous improvement.
This role is well suited to an experienced physician interested in applying clinical expertise beyond direct patient care while influencing care quality at scale.