Location: Remote (U.S.)
Job Type: Full-Time Contract with Potential for Permanent Hire
Schedule: 40 Hours Per Week
Start Date: ASAP
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.
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Conduct medical necessity and utilization management reviews
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Review escalated cases using established medical policies and clinical criteria
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Complete prior authorization reviews
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Support appeals and grievance determinations
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Participate in peer-to-peer discussions with treating providers
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Ensure compliance with NCQA, CMS, URAC, and regulatory requirements
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Provide clinical expertise on complex utilization management cases
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Collaborate with clinical and operational leadership teams
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MD or DO
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Board Certified
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Active, unrestricted medical license
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Must hold an active license in at least one of the following states:
- Pennsylvania (PA)
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New York (NY)
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West Virginia (WV)
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Multiple years of payer-side utilization management experience as a Medical Director
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Direct health plan utilization review experience
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Strong knowledge of managed care operations and medical necessity criteria
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Ability to work independently in a remote production environment
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Medicare Advantage experience
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Commercial health plan experience
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Prior authorization review experience
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Appeals and grievance review experience
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Peer-to-peer review experience
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Multi-state licensure
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Experience with InterQual and/or MCG criteria
Fully Remote
Stable Full-Time Schedule
Contract-to-Hire Potential
Meaningful Impact Within a National Health Plan
Fast Interview Process
Immediate Start Opportunity
For California Applicants:
We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO) , and the California Fair Chance Act (CFCA).
This position is subject to a background check based on its job duties, which may include patient care, working with vulnerable populations, access to financial and confidential information, driving, working with heavy machinery, or working in a warehouse or laboratory environment. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients.
