Remote Medical Director: Utilization & Quality

The Judge Group; Baltimore (MD); Remote; USD 180,000 - 240,000; Full time

Job summary

The Judge Group is seeking a Medical Director – Utilization Management to provide clinical leadership across utilization management, appeals, quality, and clinical operations. This remote, full-time role reports to senior leadership and drives cost-effective, high-quality care.

Responsibilities include peer-to-peer reviews, policy development, and program oversight, with collaboration across internal teams and external providers to optimize outcomes and compliance.

Qualifications

• MD/DO degree from an accredited medical school and active, unrestricted license.
• Board certification appropriate to duties (ABMS or AOA).
• Minimum of 10 years of clinical experience or equivalent education/experience.
• Must be located in a U.S. state or territory for utilization review or appeals when applicable.

Responsibilities

• Administer medical services to ensure appropriate, cost-effective care.
• Conduct peer-to-peer clinical reviews with attending physicians and providers.
• Conduct peer-to-peer appeal reviews with providers.
• Provide guidance on clinical operational aspects of assigned programs.
• Interpret policies/guidelines and regulatory requirements to support decisions.
• Develop and update medical policies based on changing clinical practice and regulations.
• Lead and implement clinical and non-clinical activities affecting quality and cost of care.
• Represent the organization with external entities and committees.

Skills

Clinical leadership

Communication

Regulatory knowledge

Peer-to-peer education

Education

MD/DO degree

Medical license (Active)

Board certification (ABMS/AOA)

Job description

The Judge Group is seeking a Medical Director – Utilization Management to provide clinical leadership across utilization management, appeals, quality, and clinical operations. This remote, full-time role reports to senior leadership and drives cost-effective, high-quality care.

Responsibilities include peer-to-peer reviews, policy development, and program oversight, with collaboration across internal teams and external providers to optimize outcomes and compliance.