Medical Director

The Judge Group; Baltimore (MD); Remote; USD 180,000 - 240,000; Full time

Job summary

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 care.

Responsibilities include peer-to-peer reviews, policy development, and program oversight, with collaboration across internal teams and external providers to optimize outcomes and compliance.

Qualifications

• MD/DO degree from an accredited medical school and active, unrestricted license.
• Board certification appropriate to duties (ABMS or AOA).
• Minimum of 10 years of clinical experience or equivalent education/experience.
• Must be located in a U.S. state or territory for utilization review or appeals when applicable.

Responsibilities

• Administer medical services to ensure appropriate, cost-effective care.
• Conduct peer-to-peer clinical reviews with attending physicians and providers.
• Conduct peer-to-peer appeal reviews with providers.
• Provide guidance on clinical operational aspects of assigned programs.
• Interpret policies/guidelines and regulatory requirements to support decisions.
• Develop and update medical policies based on changing clinical practice and regulations.
• Lead and implement clinical and non-clinical activities affecting quality and cost of care.
• Represent the organization with external entities and committees.

Skills

Clinical leadership

Communication

Regulatory knowledge

Peer-to-peer education

Education

MD/DO degree

Medical license (Active)

Board certification (ABMS/AOA)

Job description

Medical Director – Utilization Management

Location: Remote
Reports to: Senior Medical Director or Clinical Operations Leadership
Employment Type: Full-Time

Position Summary

The Medical Director is responsible for the administration of physical and/or behavioral health medical services to ensure members receive appropriate, high-quality, and cost-effective care. This role provides clinical and strategic leadership across utilization management, appeals, quality, and clinical operations, and may oversee an entire clinical program.

The Medical Director serves as a clinical advisor and subject-matter expert, supporting clinicians, providers, internal stakeholders, and Medical Director Associates to improve quality, outcomes, operational effectiveness, and cost of care.

Key Responsibilities

• Administer physical and/or behavioral health medical services to ensure appropriate and cost-effective care.
• Conduct peer-to-peer clinical reviews with attending physicians, ordering providers, and other treating clinicians to discuss utilization review determinations.
• Conduct peer-to-peer clinical appeal reviews with providers to discuss appeal determinations and clinical rationale.
• Support clinicians to ensure timely, consistent, and clinically appropriate responses to members and providers.
• Provide guidance on the clinical operational aspects of assigned programs.
• Interpret medical policies, clinical guidelines, and regulatory requirements to support consistent review decisions.
• Develop, propose, and update medical policies based on changes in clinical practice, healthcare standards, and regulatory requirements.
• Identify and develop cost-of-care opportunities while maintaining quality of care and positive member outcomes.
• Lead, develop, direct, and implement clinical and non-clinical activities that impact healthcare quality, cost, and outcomes.
• Develop and implement programs designed to improve quality, cost, and clinical outcomes.
• Identify opportunities for innovation to increase clinical and operational effectiveness.
• Serve as a clinical resource and consultant to internal departments, including Medical Director Associates and clinical operations teams.
• May provide oversight, direction, and guidance to Medical Director Associates.
• May be responsible for the management of an entire clinical program, including program development, implementation, and ongoing oversight.
• Represent the organization with external entities, providers, regulators, and other stakeholders as needed.
• Serve on and may chair internal or external committees.
• Conduct patient office visits with providers and external physicians when applicable.

QualificationsRequired

• MD or DO degree from an accredited medical school.
• Active, unrestricted medical license to practice medicine.
• Board certification approved by the American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA), where applicable to the duties performed.
• Minimum of 10 years of clinical experience, or an equivalent combination of education and experience.
• Must be located in a U.S. state or territory when conducting utilization review or appeals considerations, unless expressly permitted by state or federal law or regulation.
• May not be located on a U.S. military base, vessel, or embassy when performing utilization review or appeals activities.

Preferred

• Experience in utilization management, utilization review, case management, clinical appeals, managed care, or health plan operations.
• Experience in physical health, behavioral health, or both.
• Experience leading clinical programs, clinical policy development, or clinical operations teams.
• Experience providing clinical consultation and peer‑to‑peer education.
• Knowledge of CMS, NCQA, state regulatory requirements, and evidence-based clinical guidelines.
• Strong communication, collaboration, and clinical leadership skills.

Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements.