Medical Director | Utilization Management | Remote
Job at a glance
Job description
Utilization Management Medical Director (Remote) | Contract-to-Hire
Location: Remote (U.S.)
Job Type: Full-Time Contract with Potential for Permanent Hire
Schedule: 40 Hours Per Week
Start Date: ASAP
About the Opportunity
We are partnering with a large national health plan to hire experienced Utilization Management Medical Directors for a high-impact remote opportunity. This role is ideal for physicians with direct payer-side utilization management experience who are looking for flexibility, meaningful work, and the potential to transition into a long-term leadership position.
This is a contract-to-hire opportunity with the possibility of permanent employment after approximately six months.
What You'll Do
- Conduct medical necessity and utilization management reviews
- Review escalated cases using established medical policies and clinical criteria
- Complete prior authorization reviews
- Support appeals and grievance determinations
- Participate in peer-to-peer discussions with treating providers
- Ensure compliance with NCQA, CMS, URAC, and regulatory requirements
- Provide clinical expertise on complex utilization management cases
- Collaborate with clinical and operational leadership teams
Required Qualifications
- MD or DO
- Board Certified
- Active, unrestricted medical license
- Must hold an active license in at least one of the following states:
- Pennsylvania (PA)
- New York (NY)
- West Virginia (WV)
- Multiple years of payer-side utilization management experience as a Medical Director
- Direct health plan utilization review experience
- Strong knowledge of managed care operations and medical necessity criteria
- Ability to work independently in a remote production environment
Preferred Qualifications
- Medicare Advantage experience
- Commercial health plan experience
- Prior authorization review experience
- Appeals and grievance review experience
- Peer-to-peer review experience
- Multi-state licensure
- Experience with InterQual and/or MCG criteria
Why This Opportunity?
✔ Fully Remote
✔ Stable Full-Time Schedule
✔ Contract-to-Hire Potential
✔ Meaningful Impact Within a National Health Plan
✔ Fast Interview Process
✔ Immediate Start Opportunity