Medical Director

Job Title: Medical DirectorJob Location: %100 Remote (Work schedule: 9am-5pm EST core hours. Flexible to time zones. Once properly trained, can adjust start time)Project Duration: 6-12 months with possible extensionW2 Position (No spncr or C2C)NOTE: 1 year in Medical Management in a Health Insurance Plan; strong knowledge of managed care industry and e xperience with MCG or InterQualNOTE: Active medical state licensure required for PA, NY, or WVJOB DESCRIPTIONWe are seeking an MD/DO for a payer-side Utilization Management role. The physician will review escalated cases for medical necessity using established criteria (MCG/InterQual), ensure compliance with NCQA/URAC/CMS standards, and participate in appeals, peer-to-peer discussions, and multidisciplinary case reviews.Key Responsibilities:Review escalated medical cases and determine medical necessityConduct peer-to-peer discussions when requiredHandle appeals and grievancesDocument clear clinical rationalesParticipate in case management discussions and guideline developmentSupport high-volume case reviews (~55+ per day)Requirements:MD or DO, Board Certified (ABMS/AOA)Active license (PA, NY, or WV required)5+ years clinical patient care experienceExperience in health plan Utilization Management (required)Strong knowledge of managed care and clinical criteria ( MCG/InterQual preferred )Note: Hospital-only UM experience is not sufficient ; Payer/Health Insurance UM experience is required.