Remote Physician Reviewer
The Judge Group, LLC
Job Title: Medical Director – Utilization Management (Contract to Hire)
Location: Fully Remote, but need license for the state (PA, NY or WV)
Schedule: 40 hours/week
Core: 9am–5pm EST (flexible after training)
Overview
Seeking experienced Medical Directors with payer-side utilization management experience to support high-volume medical necessity reviews. This is a contract-to-hire opportunity working within a structured, compliance-driven environment.
What You’ll Do
Review escalated cases against medical policy criteria to determine medical necessity
Complete initial determinations, appeals, and grievance reviews
Conduct peer-to-peer calls when required
Participate in multidisciplinary team discussions (case reviews, rounds)
Support guideline development and clinical projects
Expected throughput: 55+ cases per day
Systems: Predictal, Beacon
Required Qualifications
MD or DO
Board Certified (ABMS or AOA)
5+ years direct patient care experience
Active, unrestricted license in PA, NY, or WV
Strong clinical judgment, documentation, and communication skills
Managed care / utilization management knowledge required
Must have payer-side utilization management experience
Health plan / insurance experience required
Hospital-only UM experience will not be considered
Preferred
Experience with MCG or InterQual
Prior health plan medical management experience
MBA, MHA, or MPH
Vacancy posted 5 days ago
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