Medical Director

Position: Medical Director

Location: Fully Remote

Job Type: 6-Month Contract with Potential for Full-Time Conversion

Schedule: Full-Time (40 hours/week) | Monday–Friday | Core Hours: 9:00 AM–5:00 PM EST (Flexible after training)

We are seeking an experienced Medical Director (Non-Behavioral Health) with strong payer-side Utilization Management (UM) experience to join a leading healthcare organization. This is a fully remote contract opportunity with the potential to convert to a full-time position.

Key Responsibilities:

• Perform utilization management reviews for escalated cases using evidence-based medical policies.
• Evaluate medical necessity and appropriateness of requested services.
• Conduct peer-to-peer discussions with treating providers as needed.
• Review appeals, grievances, and other medical necessity determinations.
• Prepare clear, concise clinical rationales while ensuring compliance with NCQA, URAC, CMS, DOH, DOL, and other applicable regulations.
• Collaborate with multidisciplinary case and disease management teams.
• Participate in protocol development, quality initiatives, and physician-led projects.

Required Qualifications:

• MD or DO from an accredited institution.
• Board Certification in an ABMS or AOA-recognized specialty.
• Active, unrestricted medical license in Pennsylvania (PA), New York (NY), or West Virginia (WV) .
• Minimum 5 years of direct patient care experience.
• Experience in Utilization Management for a health insurance payer is highly preferred.
• Strong clinical decision-making, communication, and documentation skills.

Preferred Qualifications:

• Experience with MCG and/or InterQual guidelines.
• Prior medical management experience within a health insurance organization.
• MBA or Master's in Public Health is a plus.

Additional Requirements:

• Non-Behavioral Health (Physical Health) candidates only.
• Expected productivity of 55+ case reviews per 8-hour workday .
• Experience using utilization review platforms such as Predictal and Beacon is a plus.