Medical Director Physician

medix; New York (NY); Remote; USD 180,000 - 230,000; Full time

Job summary

medix is partnering with a large national health plan to hire an experienced Utilization Management Medical Director for a fully remote opportunity in the United States. This contract-to-hire role offers flexibility, leadership potential, and the chance to influence medical necessity decisions across a payer network.

The incumbent will conduct medical necessity reviews, manage prior authorizations, and participate in appeals, while ensuring compliance with NCQA, CMS, URAC, and evolving

Qualifications

• MD or DO degree required and board certified.
• Active, unrestricted medical license with at least one state license (PA/NY/WV).
• Multiple years of payer-side utilization management experience as Medical Director.
• Direct health plan utilization review experience.
• Strong knowledge of managed care operations and medical necessity criteria.
• Ability to work independently in a remote production environment.

Responsibilities

• Conduct medical necessity and utilization management reviews.
• Review escalated cases using established medical policies and clinical criteria.
• Complete prior authorization reviews.
• Support appeals and grievance determinations.
• Participate in peer-to-peer discussions with treating providers.
• Ensure compliance with NCQA, CMS, URAC, and regulatory requirements.
• Provide clinical expertise on complex utilization management cases.
• Collaborate with clinical and operational leadership teams.

Skills

Payer-side UM experience

Remote work independence

Medical necessity criteria knowledge

Independent in remote production

Education

MD or DO

Tools

Active medical license

State licensure: PA, NY, WV

InterQual/MCG criteria knowledge

Payer-side utilization management

Job description

Utilization Management Medical Director (Remote) Contract-to-Hire

Location: Remote (U.S.)
Job Type: Full-Time Contract with Potential for Permanent Hire
Schedule: 40 Hours Per Week
Start Date: ASAP

About the Opportunity

We are partnering with a large national health plan to hire experienced Utilization Management Medical Directors for a high-impact remote opportunity. This role is ideal for physicians with direct payer-side utilization management experience who are looking for flexibility, meaningful work, and the potential to transition into a long-term leadership position.

This is a contract-to-hire opportunity with the possibility of permanent employment after approximately six months.

What You'll Do

• Conduct medical necessity and utilization management reviews
• Review escalated cases using established medical policies and clinical criteria
• Complete prior authorization reviews
• Support appeals and grievance determinations
• Participate in peer-to-peer discussions with treating providers
• Ensure compliance with NCQA, CMS, URAC, and regulatory requirements
• Provide clinical expertise on complex utilization management cases
• Collaborate with clinical and operational leadership teams

Required Qualifications

• MD or DO
• Board Certified
• Active, unrestricted medical license
• Must hold an active license in at least one of the following states:
  • Pennsylvania (PA)
  • New York (NY)
  • West Virginia (WV)
• Multiple years of payer-side utilization management experience as a Medical Director
• Direct health plan utilization review experience
• Strong knowledge of managed care operations and medical necessity criteria
• Ability to work independently in a remote production environment

Preferred Qualifications

• Medicare Advantage experience
• Commercial health plan experience
• Prior authorization review experience
• Appeals and grievance review experience
• Peer-to-peer review experience
• Multi-state licensure
• Experience with InterQual and/or MCG criteria

Why This Opportunity?

Fully Remote

Stable Full-Time Schedule

Contract-to-Hire Potential

Meaningful Impact Within a National Health Plan

Fast Interview Process

Immediate Start Opportunity