Job Description
Pay Rate:
Start Date: ASAP
End Date: 6-month contract with potential for hire
Schedule: Full-time, 40 hours per week with rotating weekend coverage
Reports To: Lead Medical Director
Description
We are seeking experienced Medical Directors to support medical review operations in a remote, U.S.-based role. This position involves reviewing submitted medical records, synthesizing complex hospital-based clinical scenarios, and making expert determinations on requested services. The role requires regular communication with external providers by phone to gather additional clinical information and discuss final decisions.
The ideal candidate demonstrates strong clinical judgment, professionalism, integrity, and the ability to work collaboratively in a structured, team-based environment. Medical Directors are expected to understand and follow established processes, support organizational values, and maintain a consistent approach to clinical decision-making.
Job Responsibilities: Conduct comprehensive, timely, and compliant medical necessity reviews for inpatient services
Apply national guidelines, CMS regulations, organizational policies, and clinical standards to medical necessity decisions
Maintain accountability for productivity, quality, and compliance metrics
Clearly communicate determinations both verbally and in writing
Demonstrate adaptability to evolving workflows, tools, and utilization management practices
Work independently after structured and mentored training while maintaining team collaboration
Ensure consistency in analytical approach, documentation, and decision-making Qualifications: Required:
MD or DO degree
Minimum 5 years of direct clinical patient care experience post-residency or fellowship (preferably with inpatient experience and/or Medicare patient populations)
Current ABMS board certification in an approved medical specialty
Active and unrestricted medical license in at least one U.S. jurisdiction, with willingness to obtain additional licensure if needed
No current sanctions from federal or state governmental organizations; able to meet credentialing standards
Excellent written and verbal communication skills
Demonstrated analytical skills and experience working in a team environment
Preferred:
Knowledge of Medicare Advantage, Managed Medicaid, Commercial plans, or other managed care organizations
Utilization management experience (e.g., within Medicare Advantage or Commercial health insurers)
Familiarity with national guidelines such as MCG® or InterQual
Hospital-based clinical experience in Internal Medicine, Family Practice, Geriatrics, Hospitalist Medicine, Emergency Medicine, or other inpatient specialties
Technological proficiency and a passion for innovation to improve workflows
Ability to thrive in a fast-paced, team-oriented environment
Participation in educational activities such as conferences, presentations, or content creation
Working Hours: Full-time: 40 hours per week
Includes rotating weekend coverage to ensure timely case decisions
Remote work from anywhere within the United States
Must reside in the U.S.
Skills: Strong clinical judgment and analytical reasoning
Excellent written and verbal communication
Ability to synthesize complex clinical information
Adaptability to changing workflows and tools
High professionalism, integrity, and decision-making consistency
Resourcefulness and the ability to work both independently and collaboratively
Technological proficiency and comfort using digital platforms
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