Remote Medical Director, Utilization Management

CAI; Annapolis (MD); Remote; USD 234,000 - 276,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401k retirement plan

Paid time off

Remote work

Job summary

CAI is seeking a Medical Director to ensure utilization management responsibilities are performed in accordance with the highest and most current clinical standards. This full‑time, remote role supports our nationwide client base while offering worksite flexibility.

You will conduct electronic reviews, prepare clear rationales, participate in multidisciplinary teams, and help develop protocols to standardize reviews.

Responsibilities

• Conduct electronic review of escalated cases against medical policy criteria, which may include telephonic peer-to-peer discussions, to determine medical necessity and appropriateness
• Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned
• Compose clear and concise rationales for members and provider determination notifications while adhering to required compliance standards (NCQA, URAC, CMS, DOH, and DOL regulations, etc.)
• Ensure that all aspects of the medical management process are consistent with community standards of care
• Participate as a member of the CMDM multidisciplinary team: attend huddles and grand rounds, and advise the multidisciplinary team on cases requiring physician expertise
• Participate in protocol and guidelines development to ensure consistency in the review process
• Actively manage projects and/or participate on project teams that require a physician subject matter expert

Job description

CAI is seeking a Medical Director to ensure utilization management responsibilities are performed in accordance with the highest and most current clinical standards. This full‑time, remote role supports our nationwide client base while offering worksite flexibility.

You will conduct electronic reviews, prepare clear rationales, participate in multidisciplinary teams, and help develop protocols to standardize reviews.