Physician Medical Director

Job Title: Medical Director – Utilization Management (Contract to Hire)

Location: Fully Remote (U.S. Only)

Work Authorization: U.S. Citizen required

Overview

Seeking experienced Medical Directors with payer-side utilization management experience to support high-volume medical necessity reviews. This is a contract-to-hire opportunity working within a structured, compliance-driven environment.

Key Details

• Contract: 6/1/2026 – 12/31/2026 (potential to convert)
• Schedule: 40 hours/week
• Core: 9am–5pm EST (flexible after training))

What You'll Do

• Review escalated cases against medical policy criteria to determine medical necessity
• Complete initial determinations, appeals, and grievance reviews
• Conduct peer-to-peer calls when required
• Write clear, compliant clinical rationales
• Participate in multidisciplinary team discussions (case reviews, rounds)
• Support guideline development and clinical projects

Volume / Tools

• Expected throughput: 55+ cases per day
• Systems: Predictal, Beacon

Required Qualifications

• MD or DO
• Board Certified (ABMS or AOA)
• 5+ years direct patient care experience
• Active, unrestricted license in PA, NY, or WV
• Strong clinical judgment, documentation, and communication skills
• Managed care / utilization management knowledge required

Critical Requirement (Will Screen Heavily)

• Must have payer-side utilization management experience
• Health plan / insurance experience required
• Hospital-only UM experience will not be considered

Preferred

• Experience with MCG or InterQual
• Prior health plan medical management experience
• MBA, MHA, or MPH