Remote Medical Director - Utilization Management (Remote)
$240kMrioa
Who We Are - Motivated by Purpose. Powered by Clinical Expertise. Founded in 1983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations. Excellence starts with our people. WE OFFER A competitive compensation package Benefits include healthcare, vision, and dental insurance A generous 401(k) match Paid vacation, PTO, and holidays Growth and training opportunities An award-winning remote work environment Position Summary Our Medical Director, also known as a Physician Advisor, is responsible for performing clinical utilization management, peer review activities, and clinicalquality management activities. Key Responsibilities Perform utilization management case reviews. Maintain productivity score per company standard. Maintain annual quality score per company standard. Complete annual inter-rater reliability testing. Train across all queues as requested by MRIoA leadership. Complete all client specific training as requested by MRIoA leadership. Maintain up-to-date records of case completion if required Consistently show willingness to take cases as requested. Demonstrate respect in interactions across the company. Consistently submit scheduling requests at least three months in advance. Consistently work scheduled hours. Provide ideas for promotion and growth of the company as requested (i.e. contribute to the vision of the company). Respond appropriately and in a timely manner to licensing/CME requests from the Senior Medical Directors, Vice President of Medical Affairs, or Chief Medical Officer and/oradministrative team. Actively participate in the MRIoA evaluation process (both company and individual). Participate in all company meetings and committees as requested. Complete other duties as requested or approved by the CEO and/or chief medical officer. Thorough understanding of the Company’s clients, products, departments, workflows, and applicable regulatory requirements and accreditation standards Work Schedule 40 hours per week Five 8-hour shifts or four 10-hour shifts (available after training) Shifts scheduled between6:00 AM – 7:00 PM MST Includes2–3 weekend rotating shifts per month Schedules are fixed and released60 days in advance Compensation & Expanded Benefits Base salary: $240,000 per year 20 days of Paid Time Off per year 6 company Holidays (New Year’s, Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas) and 1 Floating Holiday 8 days of Paid Sick Leave Medical and Prescription Benefits administered by Aetna Dental and Vision benefits Basic Life and Accidental Death and Dismemberment (AD&D) Insurance Short-Term & Long-term Disability insurance Skills and Experience Minimum of five years’ full-time equivalent experience providing direct clinical care to patients Minimum of five years’ experience administering utilization management and peer review programs preferred Credentialed and privileged by the Company's Credentialing Committee Obtain additional state licensure as required for the position Education: MD/DO degree Current, unrestricted medical license as required for clinical practice in a state of the United States Board certification by a medical specialty board approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) or other board recognizedby URAC preferred Additionally: Malpractice insurance is not required, as physicians do not provide direct patient care. Reviewers are covered under MRIoA's Errors and Omissions policy. Work Environment: Ability to sit at a desk,utilize a computer, telephone, and other basic office equipment is required. This role is designedto bea remote position (work-from-home). Diversity Statement: Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Drug-Free Workplace: This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment.All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information. California Consumer Privacy Act (CCPA) Information (California Residents Only): Sensitive Personal Info : MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number. Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at View email address on click.appcast.io.
$275k - $315k
...Title: Medical Director of Utilization Management Summary: Step into a strategic leadership position as the Clinical Lead for a prominent Health Plan... ...: $275,000 - 315,000 / year High-impact leadership role with a hybrid schedule (3 days remote / 2 days onsite)...Remote workFull timeWork at officeMonday to FridayShift work2 days per week- ...CAI is a global services firm seeking a Medical Director to ensure utilization management meets the highest clinical standards. The position is full-time and remote, enabling work from home while contributing to critical case reviews and policy development. The role...Remote workFull timeWork from home
- ...GuideWell Mutual Holding Corporation is seeking a Medical Director to lead all utilization management reviews (Pre-service, Post-service, Concurrent Review and Appeals) and to collaborate with physician providers and Case Managers on complex cases. The ideal candidate...Remote work
$224k - $364k
~ Locations United States FL, United States (Remote) Job Description The Medical Director will work closely with the team to perform all types of utilization management (UM) reviews, including but not limited to Pre-service, Post-service, Concurrent Review and Appeals...Remote workTemporary workPart timeWork experience placementInternshipSeasonal work- ...HJ Staffing is seeking an experienced physician leader for a remote Medical Director, Utilization Management role. You will serve as the primary clinical authority for home health authorizations and support acute, post-acute, appeals, and reviews for Medicare Advantage...Remote work
- ...CAI is seeking a Medical Director to ensure utilization management responsibilities are performed in accordance with the highest and most current clinical standards. This full‑time, remote role supports our nationwide client base while offering worksite flexibility....Remote workFull time
- ...in 1983, we’re a clinically driven, tech-enabled utilization management company offering expert clinical reviews, regulatory... ...and training opportunities An award-winning remote work environment Our Medical Director, also known as a Physician Advisor, is responsible...Remote workFull timeTemporary workWork at officeWork from homeShift workRotating shiftWeekend work
- ...CAI is seeking a Medical Director for a fully remote, full-time role to ensure utilization management aligns with top clinical standards. You will lead medical policy reviews, determine medical necessity, and guide the CMDM team. The position emphasizes physician expertise...Remote workFull time
- ...CAI is seeking a Medical Director to oversee utilization management, ensuring compliance with current clinical standards. This full-time, remote role requires board-certified MD/DO with licensure in PA, NY or WV and at least 5 years of direct patient care. You will...Remote workFull time
$200k - $250k
...Medical Director, Utilization ManagementWe are seeking a Medical Director, Utilization Management to lead utilization management, coverage determinations, and clinical appeals for... ...FL area, with a combination of onsite and remote daysMonday through Friday, standard business...Remote workHourly payFull time- ...HJ Staffing is urgently seeking a Medical Director of Utilization Management to join a leading Medicare Advantage Health Plan. This physician leader will... ...optimal outcomes and regulatory compliance. Location: 100% Remote Schedule: Full-Time, Monday – Friday (Must work PST...Remote workFull timeMonday to Friday
- ...CAI is seeking a Medical Director to oversee utilization management with a focus on clinical standards. The role is full-time and remote, offering the flexibility to impact care across the organization. The ideal candidate will hold an MD/DO, board certification, and licensure...Remote workFull time
- ...CAI is seeking a Medical Director to oversee utilization management, ensuring adherence to current clinical standards in a fully remote, full-time capacity across the United States. The role requires an MD/DO with board certification and an active state license (PA...Remote workFull time
- ...TalentLNX LLC is seeking a Medical Director, Utilization Management to lead utilization management, coverage determinations, and clinical appeals for... ...based in the Orlando, FL area with a blend of onsite and remote days. You will guide a UM team across prior authorization...Remote workFull time
$190k - $200k
...A healthcare management company is seeking a fully remote Medical Director to support their team in utilization management and clinical oversight for high-volume cases. The ideal candidate will have an MD or DO with board certification in Internal Medicine or Family Practice...Remote work- SCAN is seeking an Utilization Management Physician Medical Director to lead medical necessity determinations, prior authorizations, and reviews. This physician will influence policy, provide clinical mentorship, and ensure compliant, evidence-based decision-making while...Remote job
$222.75k - $267.3k
Altais is seeking a Medical Director of Utilization and Medical Management to drive Utilization Management policy and lead interdisciplinary teams in California. You will co-chair committees, collaborate with physician leaders, and ensure high-quality, cost-conscious patient...Remote job- ...Medical Review Institute of America is seeking a Medical Director (Physician Advisor) to lead clinical utilization management, peer review activities, and clinical quality management. This remote role reports to MRIoA leadership and offers a comprehensive compensation...Remote work
- ...Humana Inc. is seeking a Medical Director to oversee utilization management, determine service appropriateness, and ensure compliance with national guidelines and CMS requirements. The role emphasizes collaboration with clinicians and interdisciplinary teams across inpatient...Remote work
$248.5k - $373k
...$373,000.00/yearJob Area: Medical & Clinical OperationsCompany... ...medicine physician to join our Utilization Management team. Optum is a clinician-... ...work and live.The Medical Director for Utilization Management... ...the flexibility to work remotely * from anywhere within the...Remote workMinimum wageFull timeWork experience placementWork at officeLocal areaWork from home- ...Ladders is seeking an Enterprise Medical Director for a remote leadership role in the Finance & Insurance space. You will guide medical decision... ...with business and clinical stakeholders to shape utilization management and medical economics insights. The ideal candidate...Remote work
- ...Jobgether SRL is seeking a remote, part-time physician leader to oversee medical necessity reviews across home health, acute, post-acute and outpatient services... ...evidence-based care and appropriate resource utilization, applying CMS rules, coverage determinations and MCG...Remote workPart timeFlexible hours
- ...The Judge Group is seeking a Medical Director – Utilization Management to provide clinical leadership across utilization management, appeals, quality, and clinical operations. This remote, full-time role reports to senior leadership and drives cost-effective, high-quality...Remote workFull time
- ...Centene Management Company LLC is seeking a Board-certified physician to assist the Chief Medical Officer in directing medical management, quality improvement, credentialing, and utilization review for the Georgia-based program. The role requires active medical practice...Remote workWeekend work
- Centene Corp seeks a Medical Director PRN to support the CMO in directing the physician component of utilization management for the health plan units. The position is remote in Indiana, part-time (~20 hours/week), with Thursdays and Fridays as the highest priority. Board...Remote workPart timeRelief
$213.1k - $383.58k
...primary care, care for the most medically and socially complex populations,... ...serve.The JobThe Medicare Advantage Utilization Management (UM) Physician Medical Director provides physician-level clinical... ...3,580 per yearWork Mode - Mostly Remote: Employees who reside outside the...Remote workFor contractorsWork at officeLocal areaRelocation- ...Bickham Services Unlimited, LLC is seeking a Medical Director, Utilization Management to lead clinical utilization reviews for inpatient and post-acute... ...align with CMS, policies, and evidence-based criteria. Remote opportunity in New Jersey for a board-certified...Remote work
- ...A healthcare management organization is seeking a Remote Medical Director to lead the review of medical records and provide expert decision-making. This role demands a blend of clinical experience, leadership, and the ability to guide a team while ensuring compliance...Remote workContract workWeekend work
- ...CareStar, Inc. in Ohio is seeking a Clinical Services Utilization Supervisor to oversee Hamilton County and surrounding areas. You will... ...coordinate services with Medicaid and state programs. This remote with field visits role offers flexibility, competitive salary...Remote work
- ...Louisiana seeks Licensed Behavioral Health Utilization Management Professional 2 to coordinate, document, and communicate medical services and benefit determinations. This role... ...to work across multiple systems in a remote environment. Candidates must hold one of...Remote work
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