Remote Medical Director - High-Volume Utilization & Appeals
Teamware Solutions Inc.
An application made for this job — a tailored resume and cover letter that speak straight to the posting.
Job summary
Teamware Solutions Inc. is seeking a Medical Director to review escalated medical cases, determine medical necessity, and ensure compliance with clinical guidelines and health care regulations.
This 100% remote leadership role involves collaboration with multidisciplinary teams and guiding policy development. The ideal candidate holds an MD or DO, active license in PA/NY/WV, board certification, 5+ years of direct patient care, and UM experience in payer settings, with familiarity with
Qualifications
- MD or DO degree required.
- Minimum 5 years of direct patient care experience.
- Active medical license in Pennsylvania, New York, or West Virginia.
- Board certification through an ABMS- or AOA-recognized specialty board.
- Strong utilization management (UM) experience in health insurance/payer settings preferred.
- Experience with MCG or InterQual criteria.
Responsibilities
- Review escalated medical cases and determine medical necessity.
- Evaluate appeals and grievances.
- Ensure compliance with clinical guidelines and healthcare regulations.
- Collaborate with multidisciplinary teams and support policy development.
- Conduct peer-to-peer reviews and contribute to clinical governance.
Skills
Education
Tools
Job description
Teamware Solutions Inc. is seeking a Medical Director to review escalated medical cases, determine medical necessity, and ensure compliance with clinical guidelines and health care regulations.
This 100% remote leadership role involves collaboration with multidisciplinary teams and guiding policy development. The ideal candidate holds an MD or DO, active license in PA/NY/WV, board certification, 5+ years of direct patient care, and UM experience in payer settings, with familiarity with
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