Medical Director, Utilization Management

Medical Director, Utilization Management Location: New Jersey – Fully Remote Work Arrangement: Remote Job Type: Contract Contract Length: 6–9 months, with potential for extension Schedule: Standard business hours; schedule to be determined with the client Start Date: Immediate / ASAP Department: Healthcare – Utilization Management (Clinical) Reports To: Chief Medical Officer Openings: 1 Pay: Hourly, DOE About the Position Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to support a healthcare utilization management program client serving members. The Medical Director will lead and support clinical utilization management activities, with a primary focus on inpatient and post-acute care reviews. This position is responsible for ensuring timely, consistent, and appropriate medical necessity determinations based on member benefit plans, medical policies, clinical criteria, CMS regulations, and evidence-based practices. Key Responsibilities Conduct timely utilization reviews and medical necessity determinations for inpatient admissions and continued stays. Review post-acute care services, including SNF, IRF, LTACH, and home health. Evaluate the appropriateness of acute and post-acute services using MCG, InterQual, CMS criteria, commercial medical policies, and member benefit plans. Apply applicable regulatory and coverage standards based on the member's line of business. Serve as a physician reviewer for escalated, complex, or potentially adve