Medical Director – Medicaid Utilization Review

MBO Partners; Washington (District of Columbia); Remote; USD 100,000 - 140,000; Part time

Job summary

A leading company is seeking a Lead Finance Recruiter to oversee utilization management for Medicaid plans. This remote position requires a medical degree, active Washington license, and at least 10 years of clinical experience, focusing on quality care and compliance.

Qualifications

• Minimum of 10 years clinical experience, preferably in family practice or emergency medicine.
• Experience with utilization management or medical review preferred but not required.
• Ability to work Pacific Standard Time hours.

Responsibilities

• Conduct thorough clinical case reviews using proprietary systems.
• Perform peer-to-peer clinical consultations with external providers.
• Manage a caseload averaging six reviews per hour.

Skills

Clinical judgment

Decision-making skills

Communication skills

Detail-oriented

Education

Medical degree (MD or DO)

Board certification in specialty

Active medical license in Washington

Job description

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Lead Finance Recruiter | Corporate & Direct Sourcing Recruiter | CASR, CDR, CMVR, PRC, CTR

Hours: part-time PST (approximately 20 hours per week)

Location: Remote

Description:

The Medical Director will play a critical role in overseeing utilization management reviews and ensuring clinical appropriateness for Medicaid plans. You will collaborate closely with internal teams and external providers to support quality care and compliance. In this role you will:

Responsibilities:

• Conduct thorough clinical case reviews using proprietary systems to assess medical necessity based on established criteria.
• Perform peer-to-peer clinical consultations with external providers as needed to discuss case details and decisions.
• Manage a caseload averaging six reviews per hour, maintaining accuracy and efficiency in documentation and decision-making.
• Participate in internal meetings to coordinate care management and address clinical questions or concerns.
• Maintain up-to-date knowledge of clinical guidelines, policies, and regulatory requirements relevant to Medicaid utilization management.
• Ensure compliance with credentialing and licensing requirements, including maintaining an active Washington medical license.
• Provide timely and professional communication with stakeholders to support positive outcomes and resolve issues.
• Document case reviews and decisions thoroughly to maintain data integrity and support audit readiness.
• Work remotely while adhering to Pacific Standard Time hours
• Collaborate with the medical director team to continuously improve review processes and clinical criteria application.

Qualifications:

• Medical degree (MD or DO) with board certification in your specialty
• Active medical license in the state of Washington
• Minimum of 10 years clinical experience, preferably in family practice or emergency medicine
• Experience with utilization management or medical review preferred but not required
• Ability to work Pacific Standard Time hours, with flexibility for part-time or variable schedules
• Strong clinical judgment and decision-making skills for utilization review cases
• Excellent communication skills for peer-to-peer discussions and collaboration with providers
• Comfortable working independently in a remote, computer-based environment
• Detail-oriented with strong documentation and data management abilities

Note: Unless expressly allowed by state or federal law, or regulation, must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military base, vessel or any embassy located in or outside of the US.

Seniority level

• Seniority level

  Not Applicable

Employment type

• Employment type

  Contract

Job function

• Job function

  Administrative and Health Care Provider

• Industries

  Hospitals and Health Care and Medical Practices

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