Medical Director

Teamware Solutions Inc.; United States; Remote; USD 180,000 - 280,000; Full time

Job summary

Teamware Solutions Inc. is seeking a Medical Director for a 100% remote position. The role focuses on reviewing escalated medical cases, determining medical necessity, and evaluating appeals and grievances, all while ensuring adherence to clinical guidelines and healthcare regulations.

The candidate will collaborate with multidisciplinary teams, conduct peer-to-peer reviews, and support the development of clinical policies. Board-certified physicians with strong UM experience are preferred.

Qualifications

• MD or DO degree required.
• Board certification through ABMS- or AOA-recognized specialty board.
• Active medical license in PA, NY, or WV.

Responsibilities

• Review escalated medical cases.
• Determine medical necessity.
• Evaluate appeals and grievances.
• Ensure compliance with clinical guidelines and healthcare regulations.
• Collaborate with multidisciplinary teams.
• Conduct peer-to-peer reviews.
• Support clinical policy development.

Skills

Utilization management

InterQual/MCG criteria

Education

MD or DO degree

Master's degree in Business Administration, Management, or Public Health

Job description

Job Title: Medical Director - Location: 100% Remote

Job Description

Client is seeking a Medical Director to review escalated medical cases, determine medical necessity, evaluate appeals and grievances,and ensure compliance with clinical guidelines and healthcare regulations. The role involves collaborating with multidisciplinary teams,conducting peer-to-peer reviews, and supporting clinical policy development.

Required Qualifications

• MD or DO degree.
• Minimum 5 years of direct patient care experience.
• Board certification through an ABMS- or AOA-recognized specialty board.
• Active medical license in Pennsylvania, New York, or West Virginia.
• Strong utilization management (UM) experience on the health insurance/payer side is highly preferred. Hospital-based UM experience alone is not sufficient.
• Master's degree in BusinessAdministration,Management, or PublicHealth.
• At least 1 year of medical management experience with a health insurance plan.
• Experience with MCG or InterQual criteria.

Additional Requirements

• Must complete the Medical DirectorAssessment.
• Expected to review 55+ cases per 8-hour workday.
• Experience with Predicta and Beacon review systems is relevant.
• Candidates must be categorized as Behavioral Health or Non-Behavioral Health (Physical Health)duringsubmission