Medical Director

Job Title: Medical Director Job 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 extension W2 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 InterQual NOTE: Active medical state licensure required for PA, NY, or WV -- 4 Positions are available in Non-Behavioral Health JOB DESCRIPTION We 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 necessity Conduct peer-to-peer discussions when required Handle appeals and grievances Document clear clinical rationales Participate in case management discussions and guideline development Support 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 experience Experience 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.