Remote Medical Director – Utilization & Care Optimization

The Judge Group; United States; Remote; USD 179,000 - 193,000; Full time

Benefits offered by this job

Merit increases

Paid holidays

Paid Time Off

Incentive bonus programs

Medical, dental, vision

Short and long term disability

401(k) + match

Stock purchase plan

Life insurance

Wellness programs

Financial education resources

Job summary

The Judge Group is seeking a strategic Medical Director to oversee health plan medical services for national clients. The role combines clinical leadership with program oversight to ensure cost-effective, high-quality care while supporting key committees and external client relationships.

Requirements include an MD/DO, active US licensure, and ABMS/AOA board certification in Family/Internal/Emergency Medicine, with at least 10 years of clinical experience.

Qualifications

• MD or DO degree required.
• Active, unrestricted medical license to practice medicine in the United States.
• Board certification approved by ABMS or AOA in Family Medicine, Internal Medicine or Emergency Medicine.
• Location compliance: must be located within a U.S. state or territory for utilization review or appeals.
• Minimum of 10 years of clinical experience or equivalent combination of education and experience.
• Prior experience with health plans or hospital-based utilization review activities.

Responsibilities

• Provide clinical and operational guidance for utilization management.
• Support care management nursing staff for national client accounts.
• Conduct peer-to-peer clinical reviews with attending physicians.
• Develop and implement programs that improve healthcare quality and costs.
• Interpret medical policies and clinical guidelines to ensure compliance.
• Participate in on-call rotations for regulatory turnaround times.
• Represent the company as a clinical resource to clients and committees.

Skills

Clinical leadership

Utilization review

Peer reviews

Cost improvement

Stakeholder management

Education

MD/DO degree

ABMS/AOA board certification (Family/Internal/Emergency Medicine)

Job description

The Judge Group is seeking a strategic Medical Director to oversee health plan medical services for national clients. The role combines clinical leadership with program oversight to ensure cost-effective, high-quality care while supporting key committees and external client relationships.

Requirements include an MD/DO, active US licensure, and ABMS/AOA board certification in Family/Internal/Emergency Medicine, with at least 10 years of clinical experience.