Medical Director Physician

Fully RemoteMust have FL, NC or an IMLCMust live in AZ, FL, FA, or TXThis organization is a technology-driven health insurance company built on a full-stack platform with a strong focus on member-centered care. Founded in 2012, it was created to deliver the kind of health insurance experience people would want for themselves one that feels supportive, accessible, and clinically grounded.About the RoleYou will evaluate the medical appropriateness of inpatient, outpatient, and pharmacy services by reviewing clinical information and applying evidence-based guidelines.Hours: 8:00 AM 5:00 PM (local time zone)Call Rotation: One weekend every 16 weeksYou will report to the Associate Medical Director, Utilization Management.Work Location:This is a fully remote position open to candidates residing in Arizona, Florida, Georgia, or Texas. While daily work is completed from a home office, occasional travel may be required for team meetings or company events.Key ResponsibilitiesConduct timely medical reviews in alignment with established quality standardsMake clinical determinations using evidence-based criteria, internal guidelines, and sound clinical judgmentClearly and accurately document decisions and communications in workflow systems using appropriate templatesEnsure documentation is easy for members to understandMeet required turnaround times for reviewsReview escalated cases as neededParticipate in peer-to-peer discussions with treating providers to clarify clinical information and explain review outcomes, including alternative treatment options when appropriateMaintain compliance with all applicable laws and regulationsPerform other duties as assignedRequirementsBoard-certified MD or DOLicensed in Florida or North Carolina and/or eligible for or active participation in the Interstate Medical Licensure Compact (IMLCC)Minimum of 6 years of clinical practice experienceAt least 1 year of utilization review experience within a managed care or health insurance settingPreferred QualificationsLicensure in multiple statesBoard certification in Cardiology, Radiation Oncology, or NeurologyExperience with care management in the health insurance industryWillingness to obtain additional state licenses as needed, with employer supportEqual Opportunity & AccessibilityThis organization is an Equal Opportunity Employer committed to fostering an inclusive and supportive environment where individuals can bring their authentic selves to work. Applicants are evaluated solely on qualifications.Reasonable accommodations are available for candidates who need them during the application process.If you d like, I can also:Shorten this into a candidate-facing job adMake it sound more clinical or more corporateReformat it for LinkedIn or recruiter outreach