Remote Medical Director — Utilization & Care Strategy

CAI; Salt Lake City (UT); Remote; USD 234,000 - 276,000; Full time

Job summary

CAI is seeking a Medical Director to oversee utilization management, ensuring adherence to the highest clinical standards across remote operations.

The role is full-time and remote, with responsibilities including case review, clinical rationale writing, and collaboration with the CMDM team to align reviews with policy and industry requirements. Board-certified physicians with MD/DO and licensure preferred.

Qualifications

• MD or DO degree and board certification.
• Active medical license in at least one state.
• Minimum 5 years in clinical direct patient care.
• Strong critical thinking, case management, and communication skills.

Responsibilities

• Perform electronic reviews of escalated cases against policy criteria.
• Determine medical necessity and appropriateness.
• Draft clear rationales for notifications in compliance with NCQA, URAC, CMS, DOH, and DOL.

Skills

Critical Thinking

Case Management

Customer Service

Oral & Written Communication

Collaboration

Listening

Telephone Skills

General Computer Skills

Clinical Software

Managed Care

Education

MD/DO degree

Board Certification

MBA/MPH (preferred)

Tools

MCG

InterQual

Job description

CAI is seeking a Medical Director to oversee utilization management, ensuring adherence to the highest clinical standards across remote operations.

The role is full-time and remote, with responsibilities including case review, clinical rationale writing, and collaboration with the CMDM team to align reviews with policy and industry requirements. Board-certified physicians with MD/DO and licensure preferred.