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Medical Director

5c500a2b 27a7 4828 9817 166ddd8fb76e 19000101 000001 · Alabama, AL, US, AL; Arkansas, AR, US, AR; Texas, TX, US, TX; Tennessee, TN, US, TN; South Carolina, SC, US, SC; North Carolina, NC, US, NC; Mississippi, MS, US, MS; Louisiana, LA, US, LA; Georgia, GA, US, GA; Florida, FL, US, FL · Active · ADP Workforce Now Recruiting

Job facts

FieldValue
Company5c500a2b 27a7 4828 9817 166ddd8fb76e 19000101 000001
TitleMedical Director
Normalized title-
Department / team-
LocationAlabama, AL, United States
Work model-
Employment typePart Time
Salary-
Statusactive
ATS providerADP Workforce Now Recruiting
Posted / first seen2026-04-27 / 2026-05-31
Changed / last seen2026-06-06 / 2026-06-06

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Provider filtered searchThe same provider as a filtered job collection.Open
City jobsActive postings in Alabama.Open
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Linked records

Company5c500a2b 27a7 4828 9817 166ddd8fb76e 19000101 000001
Source90f336d3-98a2-4552-a8cc-bf9c40d2e4de
ATS providerADP Workforce Now Recruiting

Description

The Medical Director, Utilization Management provides clinical leadership and oversight for RxBenefits’ utilization management (UM) programs, ensuring that medical and pharmacy review activities are clinically appropriate, evidence-based, and compliant with applicable regulatory and accreditation standards. This role focuses on translating clinical knowledge into business strategy, supporting internal stakeholders in improving clinical outcomes, operational efficiency, regulatory compliance, and assisting in peer-to-peer consultation. The Medical Director also contributes to quality improvement initiatives and supports regulatory and accreditation activities impacting RxBenefits’ utilization management programs. This is a PART TIME position. Essential Job Responsibilities Include: Utilization Management Review Review and evaluate prior authorization requests submitted by staff pharmacists or clinical team members that require physician review. Conduct clinical medical necessity reviews of physician or member at the first and second levels, as appropriate. Serve as a peer-to-peer consulting physician as needed, when regulations allow Provide medical rationale and documentation supporting appeal decisions. External Review Coordination Coordinate with and audit third‑party external review agencies to ensure timely and accurate completion of third‑level appeals. Collaborate with and audit external reviewers to ensure fair, evidence‑based determinations. Utilization Management Compliance Support Utilization Management operations by providing clinical expertise for formulary‑related decisions, coverage determinations, and other benefit‑aligned activities. Assist with responsibilities related to formulary management, utilization review processes, and related initiatives (e.g., UM policies, clinical criteria updates). Serve as a member of the internal Utilization Management Committee. Collaborate with Legal and Compliance teams to ensure adherence to all applicable state and federal regulations governing medical director oversight and utilization management practices. Regulatory Oversight Serve as the Medical Director of record for multiple states for the utilization management review program. In coordination with Legal, maintain up‑to‑date knowledge of regulatory requirements related to medical necessity review, prior authorization, and appeals. Participate in internal audits, compliance reviews, and quality improvement initiatives. Support documentation and process updates to ensure regulatory readiness. Stakeholder Collaboration Serve as a thought leader on member health & welfare, benefit design and new lines of business Provide insight to clients/brokers regarding coverage determination as needed Required Skills / Experience: Doctor of Medicine or Osteopathy from an accredited institution Active, unrestricted license to practice medicine Multiple State licenses preferred 5+ years of professional medical experience after completing residency training Demonstrated experience in utilization management and prior authorization required Pharmacy knowledge required; specialty drug utilization experience preferred Strong analytical skills and problem-solving skills Ability to translate clinical insights into business strategies and client solutions Exceptional collaborative partner with internal and external stakeholders Excellent written, verbal, and presentation skills Proficiency in Microsoft Office Occasional travel required

Full job record

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Org IDfbb9ee85-fa67-46df-8b88-bb124aad783a
Source ID90f336d3-98a2-4552-a8cc-bf9c40d2e4de
Board ID90f336d3-98a2-4552-a8cc-bf9c40d2e4de
Provideradp_workforcenow
Provider Job Key937689
TitleMedical Director
Normalized Title—
Statusactive
Activeyes
Location TextAlabama, AL, US, AL; Arkansas, AR, US, AR; Texas, TX, US, TX; Tennessee, TN, US, TN; South Carolina, SC, US, SC; North Carolina, NC, US, NC; Mississippi, MS, US, MS; Louisiana, LA, US, LA; Georgia, GA, US, GA; Florida, FL, US, FL
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Team—
Employment Typepart_time
Workplace Type—
Remote Policy—
CountryUnited States
RegionAL
CityAlabama
Salary Raw—
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Source URLhttps://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=5c500a2b-27a7-4828-9817-166ddd8fb76e&ccId=19000101_000001&lang=en_US&type=JS&jobId=937689&jwId=9202046153720_1
Apply URLhttps://workforcenow.adp.com/mascsr/default/mdf/recruitment/recruitment.html?cid=5c500a2b-27a7-4828-9817-166ddd8fb76e&ccId=19000101_000001&lang=en_US&type=JS&jobId=937689&jwId=9202046153720_1
First Seen At2026-05-31 18:42:54Z
Last Seen At2026-06-06 12:50:00Z
Last Checked At2026-06-06 12:50:00Z
Last Changed At2026-06-06 12:50:00Z
Inactive At—
Source Posted At2026-04-27 17:43:00Z
Source Updated At—
Raw Payload Uris3://job-postings-prod-raw-590183727216/raw/provider=adp_workforcenow/board=5c500a2b-27a7-4828-9817-166ddd8fb76e|19000101_000001/date=2026-06-06/2026-06-06T12-49-59-661Z-12aa5ca9e5361a9a13daf6d81d16bc104f7cca8b1c801b1d2727bb0000001294.json
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    "requisitionDescription": "<div><div><div><p><span style=\"font-family:Roboto;\">The Medical Director, Utilization Management provides clinical leadership and oversight for RxBenefits&rsquo; utilization management (UM) programs, ensuring that medical and pharmacy review activities are clinically appropriate, evidence-based, and compliant with applicable regulatory and accreditation standards. This role focuses on translating clinical knowledge into business strategy, supporting internal stakeholders in improving clinical outcomes, operational efficiency, regulatory compliance, and assisting in peer-to-peer consultation. The Medical Director also contributes to quality improvement initiatives and supports regulatory and accreditation activities impacting RxBenefits&rsquo; utilization management programs. &nbsp;This is a <strong>PART TIME</strong> position.</span></p><p style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><em><u><span style=\"font-family:Roboto;\">Essential Job Responsibilities Include:</span></u></em></p><div style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><ul style=\"margin-bottom:0in;list-style-type: disc;\"><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><strong><span style=\"font-family:Roboto;\">Utilization Management Review&nbsp;</span></strong></li></ul></div><div style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><ul style=\"margin-bottom:0in;list-style-type: circle;margin-left: 0.5in;\"><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Review and evaluate prior authorization requests submitted by staff pharmacists or clinical team members that require physician review.</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Conduct clinical medical necessity reviews of physician or member at the first and second levels, as appropriate.</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Serve as a peer-to-peer consulting physician as needed, when regulations allow</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Provide medical rationale and documentation supporting appeal decisions.</span></li></ul></div><div style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><ul style=\"margin-bottom:0in;list-style-type: disc;\"><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><strong><span style=\"font-family:Roboto;\">External Review Coordination</span></strong></li></ul></div><div style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><ul style=\"margin-bottom:0in;list-style-type: circle;margin-left: 0.5in;\"><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Coordinate with and audit third‑party external review agencies to ensure timely and accurate completion of third‑level appeals.</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Collaborate with and audit external reviewers to ensure fair, evidence‑based determinations.</span></li></ul></div><div style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><ul style=\"margin-bottom:0in;list-style-type: disc;\"><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><strong><span style=\"font-family:Roboto;\">Utilization Management Compliance</span></strong></li></ul></div><div style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><ul style=\"margin-bottom:0in;list-style-type: circle;margin-left: 0.5in;\"><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Support Utilization Management operations by providing clinical expertise for formulary‑related decisions, coverage determinations, and other benefit‑aligned activities.</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Assist with responsibilities related to formulary management, utilization review processes, and related initiatives (e.g., UM policies, clinical criteria updates).</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Serve as a member of the internal Utilization Management Committee.&nbsp;</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Collaborate with Legal and Compliance teams to ensure adherence to all applicable state and federal regulations governing medical director oversight and utilization management practices.</span></li></ul></div><div style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><ul style=\"margin-bottom:0in;list-style-type: disc;\"><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><strong><span style=\"font-family:Roboto;\">Regulatory Oversight</span></strong></li></ul></div><div style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><ul style=\"margin-bottom:0in;list-style-type: circle;margin-left: 0.5in;\"><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Serve as the Medical Director of record for multiple states for the utilization management review program.</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">In coordination with Legal, maintain up‑to‑date knowledge of regulatory requirements related to medical necessity review, prior authorization, and appeals.</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Participate in internal audits, compliance reviews, and quality improvement initiatives.</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Support documentation and process updates to ensure regulatory readiness.</span></li></ul></div><div style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><ul style=\"margin-bottom:0in;list-style-type: disc;\"><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><strong><span style=\"font-family:Roboto;\">Stakeholder Collaboration</span></strong></li></ul></div><div style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><ul style=\"margin-bottom:0in;list-style-type: circle;margin-left: 67.25px;\"><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Serve as a thought leader on member health &amp; welfare, benefit design and new lines of business</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Provide insight to clients/brokers regarding coverage determination as needed</span></li></ul></div><p style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:normal;font-size:15px;font-family:\"Calibri\",sans-serif;'><em><u><span style=\"font-family:Roboto;\">Required Skills / Experience:</span></u></em></p><div style='margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family:\"Calibri\",sans-serif;'><ul style=\"margin-bottom:0in;list-style-type: disc;\"><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Doctor of Medicine or Osteopathy from an accredited institution</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Active, unrestricted license to practice medicine</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Multiple State licenses preferred</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">5+ years of professional medical experience after completing residency training</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Demonstrated experience in utilization management and prior authorization required</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Pharmacy knowledge required; specialty drug utilization experience preferred</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Strong analytical skills and problem-solving skills</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Ability to translate clinical insights into business strategies and client solutions</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Exceptional collaborative partner with internal and external stakeholders</span></li><li style=\"margin-top:0in;margin-right:0in;margin-bottom:8.0pt;margin-left:0in;line-height:106%;font-size:15px;font-family: initial;\"><span style=\"font-family:Roboto;\">Excellent written, verbal, and presentation 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