Medical Director
Castlight Health
Job Description Summary
The Utilization Management (UM) Medical Director provides clinical leadership for the UM program, ensuring members receive appropriate, high-quality care. You will oversee review guidelines, collaborate with internal teams and external partners, and drive compliance with regulatory and accreditation standards.
How will you make an impact & Requirements
CareMore Health is a physician-founded and physician-led organization that has been transforming care delivery since 1992. With 25 clinics, 65,000+ members and partnerships with 30+ health plans, we’ve built a reputation for delivering exceptional, integrated healthcare experiences to Medicare, Medicaid, and group or private plan members.
Our mission is simple: to improve health outcomes by delivering a transformative and integrated healthcare experience impacting physical, social and emotional well-being. Cultivating life-long relationships with patients, grounded in compassion and unwavering dedication to excellence in care, we’ve built care teams around our patients’ needs — including doctors, nurse practitioners, case managers, community health workers, social workers, pharmacists and specialists, all working together to produce the best outcomes possible. This people-first, value-based model ensures physicians can practice medicine the way it was meant to be practiced — with time to connect, collaborate, and truly care for patients.
Key Responsibilities
Lead the development, implementation, and periodic review of UM policies and clinical criteria
Provide physician oversight for concurrent and retrospective review activities
Approve and interpret clinical guidelines, pathways, and criteria for admission, continued stay, and discharge
Serve as the primary clinical liaison with payers, providers, and regulatory bodies
Mentor and educate UM nurses, physician reviewers, and other staff on best practices
Analyze utilization data and quality metrics to identify trends and areas for improvement
Participate in appeals and peer-to-peer discussions to resolve clinical disputes
Maintain compliance with NCQA, URAC, CMS, state regulations, and organizational standards
Qualifications
Medical degree (MD or DO) from an accredited institution
Active, unrestricted medical license in [State/Region]
Board certification in an acute-care specialty (e.g., Internal Medicine, Family Medicine, Pediatrics)
Minimum of 5 years clinical practice experience, with 2+ years in utilization management or managed care
Compensation: $263,488K - $329,360K & bonus eligible