Medical Director-Utilization Management- 257729

Medix™; Pennsylvania; Remote; USD 262,000 - 289,000; Full time

Benefits offered by this job

Company-provided equipment

Job summary

Medix is seeking a Board-Certified Utilization Management Medical Director for a fully remote role spanning Pennsylvania, New York, or West Virginia. You will perform medical necessity determinations and lead peer-to-peer reviews with treating providers.

This full-time position offers core hours 8:00 AM–5:00 PM ET and pay at $190–$210 per hour, with company-provided equipment. Active medical licensure in PA, NY, or WV is required or obtainable before start.

Qualifications

• MD or DO required.
• Board Certified in Internal Medicine or Family Medicine preferred.
• Pediatrics and OB/GYN backgrounds considered with strong payer-side experience.
• Active unrestricted medical license PA, NY, or WV or willing to obtain before start.

Responsibilities

• Perform physician-level medical necessity determinations across Commercial, Medicare, and Medicaid populations
• Review prior authorization requests, appeals, and grievances
• Conduct peer-to-peer discussions with treating providers
• Apply InterQual, MCG, CMS, and health plan medical policy
• Collaborate with dedicated nurses, pharmacists, and care managers who prepare each case before physician review
• Work within a streamlined, technology-enabled workflow designed for efficient, high-quality case review

Skills

Board Certified

Clinical decision-making

Education

MD or DO

Job description

Utilization Management Medical Director | Pennsylvania, New York, or West Virginia

110% Remote | Paying $190 - 210/hour | Equipment Provided

Calling All Health Plan Medical Directors & Physician

Reviewers

We're partnering with one of the nation's leading health plans to hire Board Certified physicians with Health Plan Utilization Management experience.

If your background includes medical necessity determinations, prior authorization, appeals, and grievances, and peer-to-peer reviews at or for a health plan, we'd love to connect.

What You'll Do

• Perform physician-level medical necessity determinations across Commercial, Medicare, and Medicaid populations
• Review prior authorization requests, appeals, and grievances
• Conduct peer-to-peer discussions with treating providers
• Apply InterQual, MCG, CMS, and health plan medical policy
• Collaborate with dedicated nurses, pharmacists, and care managers who prepare each case before physician review, allowing you to focus on clinical decision-making
• Work within a streamlined, technology-enabled workflow designed for efficient, high-quality case review

Why Join?

• 100% Remote - Company-issued equipment provided
• Paying $190 - 210/hour based on relevant Health Plan experience
• Full time Monday-Friday schedule with core hours of 8:00 AM - 5:00 PM ET
• Flexibility for appointments and personal commitments while maintaining core business hours
• Dedicated clinical support teams streamline case preparation so physicians can focus on reviewing cases—not administrative work
• Collaborative, production-focused environment with strong clinical and operational support

Qualifications

• MD or DO
• Board Certified in one of the following preferred specialties:
  • Internal Medicine
  • Family Medicine
• Pediatrics and OB/GYN backgrounds will also be considered with strong payer-side
• Current or recent experience as a:
  • Health Plan Medical Director
• Experience with:
  • Medical Necessity Determinations
  • Appeals & Grievances
  • Commercial, Medicare, and/or Medicaid populations
  • InterQual and/or MCG
• Active unrestricted medical license required. Must currently hold, or be willing to obtain prior to start, an active medical license in Pennsylvania, New York, or West Virginia

Ideal Background

• We're especially interested in physicians currently working within:
• Managed Care Organizations
• Payer-side Medical Director or Physician Reviewer roles
• High-volume medical necessity review environments

Ready for Your Next Opportunity?

If you're a Health Plan Medical Director or Physician Reviewer looking for a fully remote opportunity where you can focus on evidence-based clinical decision-making in a highly efficient Utilization Management environment, we'd love to connect.