Medical Director

Job Title: Medical Director

Location: 100% Remote PA, NY or WV

Duration: 6+ Months on W2

Job Summary

We are seeking an experienced Medical Director (MD/DO) to join a physician team supporting utilization management, clinical case reviews, and multidisciplinary case and disease management.

The Medical Director will review escalated cases, evaluate medical necessity and appropriateness of requested treatments or services, participate in telephonic peer-to-peer discussions, and provide clinical guidance on complex and high-risk cases.

Key Responsibilities:

Review escalated cases against medical policy criteria and determine medical necessity

Complete initial determinations, appeals, grievances, and other clinical reviews

Participate in peer-to-peer discussions with providers when required

Prepare clear and concise clinical rationales and determination notifications

Advise multidisciplinary teams on complex and high-risk cases

Support development of clinical protocols and guidelines

Participate in physician-led projects and clinical initiatives

Ensure compliance with NCQA, URAC, CMS, DOH, and DOL requirements

Required Qualifications:

MD or DO degree with recognized board certification

5+ years of direct clinical/patient care experience

Active medical license in PA, NY, or WV, or willingness to obtain the required license before start

Experience with Utilization Management, Managed Care, Case Management, and Medical

Necessity Reviews

Strong critical thinking, clinical judgment, communication, and collaboration skills

Experience with clinical software and general computer systems

Glider Assessment Test Required