Physician Reviewer (UM Medical Director)

Physician Advisor (UM Medical Director)

Full-Time | Remote (United States)

Medical Review Institute of America (MRIoA) is a nationally established organization specializing in utilization management and clinical review services. With more than four decades of industry leadership, MRIoA partners with clients nationwide to deliver consistent, evidence‑based medical determinations. We are currently seeking a full‑time Associate Medical Director (Physician Advisor) to support our expanding remote physician team.

(Physicians interested in PRN opportunities may contact Medical.Opportunities@mrioa.com.)

Role Summary

The Associate Medical Director serves as a clinical expert responsible for reviewing requests for medical services and rendering coverage determinations in accordance with benefit plans, medical policies, and clinical guidelines. This role requires sound clinical judgment, clear and defensible documentation, and the ability to collaborate with physicians across multiple specialties. Peer‑to‑peer discussions with treating providers may be conducted as part of the review process.

Key Duties and Responsibilities

• Conduct utilization and medical necessity reviews using benefit language, medical policies, and evidence‑based guidelines
• Apply benefit interpretation to ensure accurate, compliant, and well‑supported determinations
• Prepare detailed documentation that meets regulatory, accreditation, and internal quality standards
• Participate in peer‑to‑peer conversations with treating clinicians when required
• Work collaboratively with Medical Directors across regions and specialties to support consistent clinical decision‑making

Compensation and Benefits

• Full‑time, salaried position with 100% remote work environment
• Robust benefits package including:
• Medical, dental, and vision insurance
• 401(k) plan with generous employer matching
• 35 days of paid time off annually
• All required computer equipment provided
• Opportunity to join a stable, well‑established organization with long‑standing industry credibility

Schedule and Work Requirements

• Standard 40‑hour workweek
• Schedule options include five 8‑hour shifts or four 10‑hour shifts (available following completion of training)
• NOTE: The schedule is not flexible, we set the schedule requirements
• Work hours scheduled between 6:00 a.m. and 7:00 p.m. MST (8:00 a.m. to 9:00 p.m. EST)
• Expectation of 2–3 weekend shifts per month
• Schedules are finalized and released 60 days in advance
• Assigned schedules are fixed and require full availability during scheduled hours
• A hard‑wired Ethernet internet connection is required; Wi‑Fi connections are not permitted due to security standards

Requirements:

To be eligible for this position, candidates must meet the following criteria:

• Hold an active, unencumbered state licensure as a Medical Doctor (MD/DO), any state. 
• Hold current board certification in either Family Medicine or Internal Medicine (no other board-certified specialty is currently needed).
• Possess a minimum of 5 years of direct patient care experience, with the most recent experience no less than 6 months ago (recent clinical care is essential).
• Have recently (within the past 2 years) work in an inpatient/hospital setting.
• Highly skilled with a variety of computer software programs (will be trained on many)
• Be willing to obtain up to 20 additional state licenses (MRIoA covers the cost of licenses and CME requirements to maintain them).
• Have a clean background, without prior licensure issues, pending malpractice cases or legal issues.
• Possess excellent verbal and written communication skills.
• Excellent interpretation skills, divergent/creative thinking skills.
• Excellent interpretation skills, divergent/creative thinking skills are essential!

Additionally:

• Must be fully dedicated to the job during your scheduled hours. This is a busy position and does not allow for caregiving responsibilities during scheduled work hours.
• Malpractice insurance is not required, as physicians do not provide direct patient care. Reviewers are covered under MRIoA's Errors and Omissions policy.

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

 This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Workers are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

California Consumer Privacy Act (CCPA) Information:

• Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.

Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com.