Medical Director - Utilization Management 253754

Medical Director - Utilization Management (Remote)We are actively seeking experienced Utilization Management Medical Directors for a high-impact payer-side opportunity supporting medical management operations within an established health plan environment.This is an excellent opportunity for physicians with direct health plan UM experience who can step into a fast-paced review environment and make an immediate impact.Location: Fully Remote – Candidates may reside anywhere in the U.S.Schedule: Full-Time Preferred (40 hrs/week)Compensation: $130–140/hourEmployment Type: Contract-to-Hire | Initial 6–12 Month EngagementPotential for permanent conversion after approximately 6 monthsTarget Start Date: 6/22/2026Key Responsibilities:Conduct utilization management reviews for medical necessity and appropriateness of careReview escalated and complex cases using evidence-based guidelines and medical policy criteriaParticipate in peer-to-peer discussions with providersSupport prior authorizations, appeals, and grievancesEnsure compliance with NCQA, CMS, URAC, and regulatory standardsCollaborate with clinical and operational leadership teamsMaintain productivity expectations within a payer-side review environmentRequired Qualifications:MD or DO requiredBoard Certified physicianActive, unrestricted medical licenseMust hold at least one active license in PA, WV, or NYMultiple years of payer-side utilization management experience at the Medical Director levelPrior health plan utilization review experience requiredStrong knowledge of managed care operations and medical necessity criteriaExperience with prior authorization, appeals/grievances, and peer-to-peer reviewsFamiliarity with NCQA, CMS, and URAC standardsInterQual and/or MCG experience preferredPreferred Background:Medicare Advantage and/or Commercial plan experienceMulti-state licensureInpatient and outpatient UM review experienceFamiliarity with Epic and payer-side review platformsExperience supporting large health plans or managed care organizationsWhy This Opportunity?Fully remote flexibilityStable full-time schedule with work-life balanceImmediate impact within an established UM operationStrong long-term potentialFast interview process and quick feedback