Medical Director (Utilization Review)

Location: Remote (U.S.)

This fully remote position offers the flexibility to work from home full-time, with occasional travel required for onboarding, training, team meetings, or business needs. Candidates must reside within a reasonable commuting distance of designated business locations unless otherwise required by law.

Position Summary

The Medical Director is responsible for overseeing clinical and medical management activities to ensure members receive appropriate, evidence-based, and cost-effective healthcare services. This role supports a large national client population and partners with clinical operations, care management, utilization management, and client leadership teams to improve healthcare quality, optimize outcomes, and manage healthcare costs.

The Medical Director serves as a clinical leader, strategic advisor, and subject matter expert, helping to develop and implement programs that enhance clinical effectiveness, member experience, and overall value for clients and members.

Key Responsibilities

• Work independently with guidance and oversight from leadership.
• Provide physician leadership and support for utilization management and care management programs.
• Serve as a clinical resource for nursing staff and interdisciplinary teams.
• Offer guidance on clinical and operational matters affecting assigned client populations.
• Conduct peer-to-peer consultations with attending physicians regarding utilization review determinations and appeals.
• Participate in an on-call rotation, including approximately two two-week blocks annually, to support regulatory turnaround requirements during non-business hours.
• Act as a consultant to internal departments on medical policy, clinical guidelines, and healthcare management strategies.
• Represent the organization with clients, provider groups, and external stakeholders.
• Interpret and apply medical policies, clinical guidelines, and evidence-based standards of care.
• Lead and support initiatives that improve healthcare quality, affordability, member outcomes, and operational effectiveness.
• Identify opportunities for innovation and process improvement that enhance the value of healthcare services.
• Participate on internal and external committees, advisory groups, and strategic initiatives as requested.

Required Qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
• Board Certification through an American Board of Medical Specialties (ABMS) or American Osteopathic Association (AOA) recognized board, in Internal Medicine, Family Medicine or Emergency Medicine.
• Active, unrestricted medical license in Maryland.
• Minimum of 10 years of clinical practice experience, or an equivalent combination of education and experience.
• Strong understanding of healthcare delivery systems, clinical quality measures, and evidence-based medicine.
• Ability to conduct peer-to-peer reviews and make sound clinical determinations.
• Excellent communication, leadership, and stakeholder management skills.

• Experience working for a health plan, managed care organization, or payer environment.
• Experience in utilization management, case management, or hospital-based utilization review.
• Familiarity with population health management and value-based care models.
• Experience supporting large national employer groups or complex healthcare populations.
• Demonstrated ability to influence clinical strategy and operational performance.

Work Requirements

• Must be located within the United States while performing utilization review or appeals-related activities, unless otherwise permitted by applicable laws and regulations.
• Ability to participate in scheduled on-call coverage as required.
• Occasional travel may be required for meetings, training, or client engagements.

Compensation & Benefits

Hourly salary - $135.00 - $140.00

Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements.

Equal Opportunity Employer

We are committed to creating an inclusive workplace and providing equal employment opportunities to all qualified applicants and employees. Employment decisions are made without regard to race, color, religion, sex, gender identity, sexual orientation, national origin, age, disability, veteran status, or any other status protected by applicable law.

Medical, dental, and vision insurance are available to qualified candidates who meet eligibility requirements.

By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively “Judge”) to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge's Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.