Medical Director - Outpatient 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 - Outpatient Medicare based in the United States. This is a senior clinical leadership role focused on utilization management and medical necessity decisions for Medicare populations.You will apply your clinical expertise and professional judgment to complex cases, balancing quality of care, regulatory requirements, and appropriate resource utilization.The role involves reviewing clinical documentation and claims while applying Medicare policies, national guidelines, and evidence-based standards.You will regularly collaborate with physicians, care management teams, and other healthcare professionals to resolve complex cases and support optimal outcomes.The position also provides opportunities to contribute to appeals, quality initiatives, population health, and broader healthcare transformation efforts.This fully remote role offers flexibility while connecting you with multidisciplinary teams and regional healthcare partners.It is an opportunity to combine clinical practice experience with healthcare strategy, analytics, and value-b... Click Apply to read the full job description.