Remote Health Plan Utilization Management Director

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

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.