Medical Director - Utilization Management

The Judge Group; United States; Remote; USD 179,000 - 193,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical, dental, vision

Short and long term disability

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

The Judge Group is seeking a strategic Medical Director to oversee health plan medical services for national clients. The role combines clinical leadership with program oversight to ensure cost-effective, high-quality care while supporting key committees and external client relationships.

Requirements include an MD/DO, active US licensure, and ABMS/AOA board certification in Family/Internal/Emergency Medicine, with at least 10 years of clinical experience.

Qualifications

• MD or DO degree required.
• Active, unrestricted medical license to practice medicine in the United States.
• Board certification approved by ABMS or AOA in Family Medicine, Internal Medicine or Emergency Medicine.
• Location compliance: must be located within a U.S. state or territory for utilization review or appeals.
• Minimum of 10 years of clinical experience or equivalent combination of education and experience.
• Prior experience with health plans or hospital-based utilization review activities.

Responsibilities

• Provide clinical and operational guidance for utilization management.
• Support care management nursing staff for national client accounts.
• Conduct peer-to-peer clinical reviews with attending physicians.
• Develop and implement programs that improve healthcare quality and costs.
• Interpret medical policies and clinical guidelines to ensure compliance.
• Participate in on-call rotations for regulatory turnaround times.
• Represent the company as a clinical resource to clients and committees.

Skills

Clinical leadership

Utilization review

Peer reviews

Cost improvement

Stakeholder management

Education

MD/DO degree

ABMS/AOA board certification (Family/Internal/Emergency Medicine)

Job description

Location: Fully Remote (Virtual - United States based)

Position Type: Contract-to-perm | Full-Time (40 hours/week)

Position Overview

We are seeking a strategic and experienced Medical Director to manage the health plans of some of the nation’s largest companies, representing over 600 clients and 10 million lives. The Medical Director is responsible for administering medical services to ensure members receive appropriate, cost-effective care, while serving as a key clinical and strategic advisor.

• Location: Virtual (Remote) within the U.S.
• Salary Range: $130.00 - $140.00 per hour (dependent on geographic location, experience, and qualifications)
• Benefits: Offered is a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Key Responsibilities

• Clinical & Operational Guidance: Provide oversight for utilization management and support care management nursing staff for assigned national client accounts.
• Peer Reviews & Consultations: Conduct peer-to-peer clinical reviews with attending physicians to discuss review determinations.
• Quality & Cost Improvement: Develop and implement programs and clinical activities that positively impact healthcare quality, cost, and outcomes, identifying new opportunities for innovation.
• Policy & Guideline Interpretation: Interpret medical policies and clinical guidelines to ensure adherence and optimal clinical operations.
• On-Call Responsibilities: Participate in two two-week blocks of primary/back-up call per year to maintain regulatory turnaround times during non-business hours (shared equitably with other Operational Medical Directors).
• Stakeholder Representation: Serve as a clinical resource, consultant, and company representative to external clients and internal/external committees.

Requirements & Qualifications

• Licensure & Board Certification:
• MD or DO degree required.
• Must possess an active, unrestricted medical license to practice medicine in Maryland.
• Board certification approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA), in Family Medicine, Internal Medicine or Emergency Medicine.
• Location Compliance: Must be located within a U.S. state or territory when conducting utilization review or appeals considerations (cannot be located on a U.S. military base, vessel, or embassy).
• Clinical Experience: Minimum of 10 years of clinical experience, or an equivalent combination of education and experience.
• Prior experience working within a health plan or direct involvement with hospital-based utilization review activities.