Medical Director

About the Role We are seeking a Medical Director to support utilization management and medical necessity reviews within a managed care environment. Key Responsibilities Review escalated cases using medical policy criteria to determine medical necessity and appropriateness of care.

Job Title: Medical Director
Location: 100% Remote
Employment Type: Contract (W2)
Duration: 6+ Months
Rate: $150/hr W2

About the Role

We are seeking a Medical Director to support utilization management and medical necessity reviews within a managed care environment. The physician will review escalated cases, participate in peer-to-peer discussions, support multidisciplinary case management, and ensure compliance with applicable clinical and regulatory standards.

Key Responsibilities

• Review escalated cases using medical policy criteria to determine medical necessity and appropriateness of care.

• Conduct initial determinations, appeals, grievances, and other utilization reviews.

• Participate in telephonic peer-to-peer discussions when required.

• Provide physician guidance to multidisciplinary case and disease management teams.

• Support protocol/guideline development and physician-led projects.

• Maintain compliance with NCQA, URAC, CMS, DOH, DOL, and applicable clinical standards.

• Complete high-volume case reviews and provide clear, concise clinical rationale.

Required Qualifications

• MD or DO with active board certification recognized by ABMS or AOA specialty boards.

• Minimum 5 years of clinical/direct patient care experience.

• Medical management/utilization management experience from the health insurance/payer side is strongly preferred.

• Strong managed care, clinical decision-making, communication, and collaboration skills.

• Active medical license in PA, NY, or WV, or willingness to obtain the required license before start date.

• Ability to complete the required Glider Assessment.

Preferred Qualifications

• 1+ year of Medical Management experience within a health insurance plan.

• Experience with MCG or InterQual.

• Strong knowledge of the managed care industry.

• MBA, MHA, MPH, or related master's degree.

Additional Information: Candidates will be categorized as Behavioral Health or Non-Behavioral Health (Physical Health) during submission.

Salary

The hourly rate for this position is $150 per hour.

Benefits

This is a contract position and does not include employer-provided benefits.

Equal Opportunity Employer

We are an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, colour, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

Background Check

Background checks may be conducted in accordance with applicable law.

Work Authorization

Applicants must be authorized to work in the United States.