Physical Health Medical Director

Location: Remote (Preference for North Carolina Residents)
Job Type: Full-Time
Work Arrangement: Primarily Remote

About the Role

We are seeking an experienced Physical Health Medical Director to provide clinical leadership, medical oversight, and utilization management expertise within our Physical Health Medical Management team. This physician leader will support high-quality, evidence-based decision making across physical health services while driving clinical excellence, regulatory compliance, and operational efficiency.

This is primarily a remote position. Candidates residing in North Carolina or willing to relocate are strongly preferred. Occasional on-site attendance may be required based on business needs. Availability to work weekends and holidays may be necessary to meet operational requirements.

Key Responsibilities

Clinical Oversight & Utilization Management

• Review and evaluate requests for physical health services, including authorization decisions and level-of-care determinations.
• Apply evidence-based medical necessity criteria to ensure appropriate utilization of healthcare services.
• Conduct initial reviews, concurrent reviews, appeals, and utilization management activities for inpatient and outpatient services.
• Ensure compliance with regulatory standards, accreditation requirements, and organizational policies.
• Maintain expected review volumes while meeting quality and timeliness standards.

Medical Review & Decision Making

• Evaluate service requests regarding type, frequency, intensity, and duration of care.
• Approve or deny requests based on established clinical guidelines and medical necessity criteria.
• Ensure accurate documentation and consistent decision-making within utilization management systems.

Operational Leadership

• Participate in organizational committees, including:
  • Clinical Quality Review Committee
  • Transition of Care Rounds
  • Overturn Committee
• Provide clinical consultation and leadership to multidisciplinary teams, including care management and behavioral health partners.
• Support process improvement initiatives to enhance quality outcomes and operational efficiency.

External Collaboration

• Participate in mediation activities and Office of Administrative Hearings (OAH) processes as required.
• Provide expert clinical testimony, documentation support, and medical consultation.

Education & Mentorship

• Train, mentor, and support Medical Management team members.
• Assist with onboarding and development of new Physical Health Medical Directors.
• Provide education and consultation to staff, providers, and community partners.

Culture & Workforce Development

• Foster a positive, inclusive, and collaborative work environment.
• Promote diversity, equity, and respect across teams.
• Partner with Human Resources and leadership to recruit and retain top talent.
• Ensure policies and standards are applied consistently, ethically, and fairly.

Required Qualifications

Education

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from an accredited medical school.

Experience

• Minimum of 4 years of post-graduate clinical practice experience.
• Minimum of 2 years of managed care, utilization management, or medical review experience.

Licensure & Certification

• Current, active, unrestricted North Carolina medical license, or eligibility to obtain North Carolina licensure.
• Board Certification in an applicable specialty, including:
  • Family Medicine (ABFM)
  • Internal Medicine (ABIM)
  • Or other related specialty as approved.

Preferred Qualifications

• Experience in health plan medical management.
• Experience with utilization review, appeals, and level-of-care determinations.
• Experience working in Medicaid, managed care, or population health environments.
• Leadership experience in interdisciplinary healthcare settings.

Knowledge, Skills & Abilities

• Extensive knowledge of medical diagnosis, treatment, pharmacology, and preventative care.
• Strong understanding of managed care principles and utilization management.
• Knowledge of current healthcare regulations, clinical guidelines, and quality standards.
• Proficiency with Microsoft Office Suite.
• Ability to communicate effectively with physicians, healthcare professionals, and executive leadership.
• Strong analytical, decision-making, and problem-solving skills.

Compensation

Salary: Competitive and commensurate with education, experience, market conditions, and internal equity.

Benefits

We offer a comprehensive benefits package that includes:

• Medical, Dental, and Vision Insurance
• Life Insurance
• Long-Term Disability Coverage
• Generous Retirement Savings Plan
• Flexible Remote Work Environment
• Paid Vacation, Sick Time, and Holidays
• Management Leave
• Flexible Dress Code
• Career Development Opportunities

Apply now