Remote Health Plan Utilization Management Medical Director

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

Benefits offered by this job

Remote work

Company-issued equipment

Job summary

Medix in the United States is seeking Board Certified physicians with Health Plan Utilization Management experience to perform medical necessity determinations across Commercial, Medicare, and Medicaid populations.

The role also reviews prior authorization, appeals, and grievances, conducts peer-to-peer discussions with treating providers, and applies InterQual, MCG, CMS, and health plan medical policy in a fully remote setting with company-issued equipment.

Qualifications

• MD or DO with Board Certification in preferred specialties.
• Experience as Health Plan Medical Director or Physician Reviewer is highly desirable.
• Active medical license in PA, NY, or WV (or willingness to obtain) is required.

Responsibilities

• Perform physician-level medical necessity determinations across Commercial, Medicare, and Medicaid.
• 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 clinical support teams to focus on decision-making.

Skills

Utilization Management

Health Plan experience

Clinical decision-making

Education

MD/DO

Tools

InterQual

MCG

Job description

Medix in the United States is seeking Board Certified physicians with Health Plan Utilization Management experience to perform medical necessity determinations across Commercial, Medicare, and Medicaid populations.

The role also reviews prior authorization, appeals, and grievances, conducts peer-to-peer discussions with treating providers, and applies InterQual, MCG, CMS, and health plan medical policy in a fully remote setting with company-issued equipment.