Medical Director (Non-Behavioral Health)

Job Title: Medical Director (Non-Behavioral Health) Remote | Contract to Hire

Location: Fully Remote (U.S.)

Client Location: Pittsburgh, PA



Job Type: 6-Month Contract with Potential for Full-Time Conversion



Schedule: 40 hours/week | Monday Friday | Core Hours: 9:00 AM 5:00 PM EST (Flexible after training)



Pay Rate: $180 $200/hour (W-2)



Start Date: September 21, 2026

We are seeking an experienced Medical Director (Non-Behavioral Health) with a strong background in Utilization Management (UM) on the payer/health insurance side . This is a fully remote opportunity with the potential to convert to a full-time position.

Key Responsibilities

• Review escalated utilization management cases using evidence-based medical policy criteria.

• Determine medical necessity and appropriateness of requested treatments and services.

• Conduct peer-to-peer discussions with treating providers when required.

• Review appeals, grievances, and other medical necessity determinations.

• Prepare clear, evidence-based clinical rationales for determination letters.

• Ensure compliance with NCQA, URAC, CMS, DOH, DOL, and other regulatory requirements.

• Collaborate with multidisciplinary case and disease management teams.

• Participate in clinical discussions, protocol development, and quality improvement initiatives.

• Serve as the physician subject matter expert on medical management projects.

Required Qualifications

• MD or DO from an accredited institution.

• Active, unrestricted medical license in Pennsylvania (PA), New York (NY), or West Virginia (WV) .

• Board Certified in an ABMS or AOA-recognized specialty.

• Minimum 5 years of direct clinical patient care experience.

• Prior Utilization Management experience with a health insurance payer (strongly preferred and highly valued).

• Excellent clinical judgment, communication, and documentation skills.

Preferred Qualifications

• Medical management experience within a health insurance plan.

• Experience using MCG or InterQual criteria.

• Familiarity with utilization review platforms such as Predictal and Beacon .

• MBA or Master's in Public Health (preferred but not required).

Additional Information

• Non-Behavioral Health (Physical Health) candidates only.

• U.S. Citizenship is required.

• Candidates must successfully complete the Medical Director Assessment (Glider) .

• Productivity expectation: 55+ case reviews per 8-hour workday.