Medical Director

Top Healthcare company is hiring a Physical Health Medical Director to work remotely in North Carolina.

The Physical Health Medical Director plays a key role within the Physical Health Medical Management Team, providing clinical oversight, medical expertise, and operational support for physical health services. This position ensures high quality, evidence based medical review processes and supports organizational goals related to clinical quality, utilization management, and care coordination.

This position will allow the successful candidate to work primarily remote.

While there is no expectation to be in the office routinely, the selected candidate may be required to report on-site as needed. It's strongly preferred that the selected candidate reside in North Carolina or be willing to relocate.

This position may be required to work weekends and holidays based on organizational and operational requirements.

Responsibilities & Duties

Clinical Oversight & Medical Review

Provide expert guidance and oversight for physical health service requests, including authorization of services and determination of appropriate level of care

Ensure the integrity and quality of utilization management activities, including initial reviews, concurrent reviews, appeals, and level of care determinations for inpatient and outpatient services

Participate in internal reviews of inpatient and outpatient clinical case types to ensure compliance with regulatory, accreditation, and organizational standards

Review Approval and Denial of Service and Level of Care Requests

Apply medical necessity criteria utilizing review criteria hierarchy for level of care and services regarding type, amount, and duration of service. Complete expected case volume as expected by the department

Process Adherence, Quality & Efficiency

Follow department processes-as defined by approved policies, desk procedures, and workflows referenced on the Company Grid and in the Medical Director OneNote-to complete timely utilization reviews in UM platform and perform tasks efficiently

Apply established workflows and maintain quality case reviews to ensure consistent decision making, documentation accuracy, and adherence to regulatory compliance

Operational & Committee Support

Support the Clinical Operations Department through active participation in organizational committees, including but not limited to Clinical Quality Review, Transition of Care Rounds, Overturn Committee

Provide clinical guidance and leadership to promote collaboration between medical, behavioral, and care management teams

External Engagement

Participate in mediation activities and Office of Administrative Hearing (OAH) processes as required, providing clinical expertise and documentation support

Additional Responsibilities

Maintain awareness of regulatory requirements, utilization management guidelines, and emerging trends affecting utilization management and physical health services

Contribute to process improvement initiatives aimed at enhancing clinical quality, efficiency, and member outcomes

Support cross functional teams with medical expertise, as needed

Provide consultation, training, and education to staff and community partners on relevant topics as needed

Train and mentor peers within the Medical Management team and assist with onboarding PH Medical Director new hires as needed

Maintain a Positive Environment

Work with Human Resources and Medical Team to attract, maintain, and retain a highly qualified and well-trained workforce

Actively establish and promote a positive, diverse, and inclusive working environment that builds trust with teammates

Ensure all staff are treated with respect and dignity

Ensure standards are transparent and applied consistently, impartially, and ethically over time and across all staff members

Minimum Requirements

Education & Experience

Graduation from an accredited Medical School. M.D./D.O. degree is required and board certification in a relevant field.

At least four (4) years of postgraduate clinical experience and two (2) or more years of managed care and utilization management experience are required.

Special Requirement

Current, active, and unrestricted license to practice medicine in North Carolina or meets qualifications to obtain a North Carolina Medical License with Board certification for appropriate field of Medicine (American Board of Family Medicine or American Board of Internal Medicine).

Knowledge, Skills, & Abilities

Knowledge of the information and techniques needed for diagnosis and treatment of medical issues, including symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures

Knowledge of Managed Care Principles

Knowledge of recent developments in the field of medicine

Microsoft Office Skills

Ability to speak with colleagues about treatment concerns, complex case issues and best practice recommendations

Utilization Management experience

An excellent fringe benefit package accompanies the salary, which includes:

Medical, Dental, Vision, Life, Long Term Disability

Generous retirement savings plan

Flexible work schedules including hybrid/remote options

Paid time off including vacation, sick leave, holiday, management leave

Dress flexibility

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact View email address on us.fitly.work.




Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).




This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.