Medical Director Physician

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 Experience: 12 years required