Neonatologist Medical Director

HireTalent; South Carolina; Remote; USD 250,000 - 350,000; Full time

Job summary

HireTalent seeks a Neonatologist Reviewing Medical Director to provide clinical leadership for NICU utilization management and neonatal operations in a virtual setting. You will review complex NICU cases, apply evidence-based criteria, and support Medicaid neonatal programs while collaborating with internal teams to ensure high-quality newborn care.

The ideal candidate is a board-certified Neonatologist with NICU utilization management experience and strong clinical expertise to make timely

Qualifications

• Board-certified Neonatologist with strong NICU utilization management experience.
• Evidence-based medical necessity determinations and Medicaid knowledge.
• Ability to perform timely, well-supported reviews and credentialing readiness.

Responsibilities

• Lead NICU clinical reviews and medical necessity determinations.
• Support Medicaid neonatal programs and neonatal clinical operations.
• Collaborate with providers, facilities, care management, and teams to improve outcomes.
• Provide cross-state utilization management guidance and policy adherence.
• Maintain knowledge of federal Medicaid regulations and neonatal policies.

Skills

Clinical leadership

Medical decision making

Regulatory compliance

Team collaboration

Medical documentation

Education

MD/DO degree

Neonatal-Perinatal Medicine board certification

Active medical license(s)

Tools

MHK

CGX

Job description

We are seeking a Neonatologist Reviewing Medical Director to provide specialized clinical leadership for Neonatal Intensive Care Unit (NICU) utilization management and neonatal clinical operations. This virtual role is responsible for reviewing complex NICU cases, applying evidence-based medical necessity criteria, supporting Medicaid neonatal programs, and collaborating with providers and internal teams to ensure high-quality care for newborns and infants.

The ideal candidate is a board-certified Neonatologist with strong NICU utilization management experience, deep clinical expertise, and the ability to make timely, consistent, and well-supported medical necessity determinations.

Responsibilities

NICU Clinical Review & Medical Necessity Determinations

• Review and evaluate NICU admissions, continued stays, level-of-care requests, transfers, and discharge-related services.
• Assess maternal, delivery, newborn, and NICU clinical documentation for medically complex neonates and critically ill newborns.
• Apply evidence-based clinical guidelines, coverage criteria, and Medicaid requirements when making determinations.
• Document clear and clinically supported medical necessity rationales.
• Evaluate gestational age, postmenstrual age, respiratory support, nutrition support, acuity, treatment needs, and discharge readiness.
• Support physician-level review of DRG validation and NICU level-of-care determinations.
• Prioritize reviews to meet regulatory, contractual, and operational turnaround requirements.
• Escalate complex or high‑risk cases according to established policies.

Clinical Operations & Medicaid Support

• Maintain expertise in federal Medicaid regulations, state‑specific requirements, and neonatal clinical policies.
• Support consistent application of neonatal utilization management standards across assigned states.
• Participate in neonatal quality improvement, care management, discharge planning, and clinical initiatives.
• Provide clinical expertise and guidance to internal teams regarding neonatal services.
• Conduct peer‑to‑peer discussions with:
• Pediatric specialists
• Hospital‑based physicians
• Treating providers
• Gather additional clinical information and discuss review outcomes.
• Manage complex clinical conversations professionally and effectively.
• Collaborate with providers, facilities, care management teams, and community stakeholders to support neonatal outcomes and care transitions.

Team & Coverage Responsibilities

• Provide cross‑coverage support during planned absences, holidays, weekends, and peak workload periods.
• Collaborate with medical directors, neonatal clinical teams, and operational partners to ensure consistency in review practices.
• Promote ethical decision‑making, regulatory compliance, and patient‑centered care.

Required Qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
• Board Certification in Neonatal‑Perinatal Medicine recognized by the American Board of Pediatrics.
• Active, unrestricted medical license in Oklahoma and/or South Carolina.
• Ability to obtain and maintain additional state licenses as required.
• Minimum 5 years of post‑training clinical practice experience in Neonatal‑Perinatal Medicine.
• Recent experience providing direct patient care within a NICU environment.
• Experience conducting NICU utilization management reviews in:
• Health plans
• Independent review organizations
• Comparable payer or clinical settings
• Ability to meet credentialing requirements.
• No current federal or state sanctions.

Preferred Qualifications

• Experience working with Medicaid populations and neonatal services.
• Experience supporting:
• NICU case management
• Concurrent review
• Appeals
• Familiarity with healthcare quality accreditation standards.
• Experience with utilization management platforms such as:
• MHK
• CGX
• Participation in or eligibility for the Interstate Medical Licensure Compact.