Utilization Management Physician-253754

Open to Part Time and Full Time!tilization Management Medical Director (Remote) Licensure Requirements (Required at Time of Submission) Active unrestricted MD or DO license Must hold an active license in at least one of the following states: Pennsylvania (PA), West Virginia (WV), or New York (NY) Multi-state licensure strongly preferred Candidates who hold an active IMLC (Interstate Medical Licensure Compact) are encouraged to apply Position OverviewMedix is partnering with a large national health plan to hire experienced Utilization Management Medical Directors for a remote contract opportunity supporting payer-side medical management operations.This role is ideal for physicians with strong health plan utilization management experience who can quickly step into a high-volume review environment with minimal ramp-up.Schedule Full-time, 40 hours/week Typical schedule: 8:30am–5:00pm Flexible scheduling available Fully Remote (work from anywhere in the U.S.) 2-day virtual training/bootcamp (8am–5pm EST) Contract Details 6–12 month contract with potential contract-to-hire opportunity Target start date: 6/1/2026 Key Responsibilities Conduct utilization management reviews for medical necessity and appropriateness of care Review escalated cases using established medical policy criteria Participate in peer-to-peer discussions with providers as needed Support prior authorizations, appeals, and grievance reviews Ensure compliance with NCQA, CMS, URAC, and regulatory standards Collaborate with clinical and operational leadership teams Provide clinical guidance on complex medical necessity cases Required Qualifications MD or DO Board Certified Active unrestricted medical license Active PA, WV, or NY license required OR active IMLC Multiple years of payer-side / health plan Utilization Management experience as a Medical Director Strong experience conducting utilization reviews in a health plan environment Strong understanding of managed care operations and medical necessity criteria Ability to work independently in a remote production-based environment Preferred Experience Medicare Advantage and/or Commercial plan experience Appeals & grievances review experience Prior authorization review experience Peer-to-peer review experience Multi-state licensure preferred Experience with InterQual, MCG, NCQA, CMS, and URAC standards Preferred BackgroundsExperience with organizations such as:UnitedHealthcare / Optum Aetna Cigna / Evernorth Humana Elevance Health (Anthem) Centene Molina Kaiser Permanente Evolent Carelon Devoted Health SCAN Health Plan What Makes This Opportunity Stand Out Fully remote opportunity with stable full-time hours Fast-moving, high-impact payer-side environment Opportunity to support national utilization management operations Strong physician autonomy with collaborative leadership support Ability to make a direct impact on care quality and medical management strategy Ideal CandidateWe are seeking physicians who:Have strong payer-side clinical judgment Communicate effectively during peer-to-peer reviews Thrive in production-based remote review environments Understand medical necessity criteria and managed care workflows Can efficiently manage high-volume case review workloadsTechnology:Epic experience preferred