Remote Health Plan Utilization Management Medical Director

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

Benefits offered by this job

Equipment provided

Job summary

Medix is seeking Board Certified physicians with Health Plan Utilization Management experience for a fully remote role. You will perform physician-level medical necessity determinations across Commercial, Medicare, and Medicaid populations, review prior authorizations, appeals, and grievances, and conduct peer-to-peer discussions with treating providers.

You will apply InterQual and MCG guidelines, collaborate with dedicated nurses and care managers, and work within a technology-enabled workflow

Qualifications

• MD or DO mandatory medical degree and medical license.
• Board certification in Internal Medicine, Family Medicine, General Surgery, or Pediatrics with payer-side Utilization Management experience.
• Current or recent Health Plan Medical Director or physician reviewer background.

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.

Education

MD or DO

Tools

InterQual

MCG

Job description

Medix is seeking Board Certified physicians with Health Plan Utilization Management experience for a fully remote role. You will perform physician-level medical necessity determinations across Commercial, Medicare, and Medicaid populations, review prior authorizations, appeals, and grievances, and conduct peer-to-peer discussions with treating providers.

You will apply InterQual and MCG guidelines, collaborate with dedicated nurses and care managers, and work within a technology-enabled workflow