Utilization Management Physician-253754

Open to Part Time and Full Time!

tilization Management Medical Director (Remote)

Licensure Requirements (Required at Time of Submission)

Active unrestricted MD or DO license

Must hold an active license in at least one of the following states: Pennsylvania (PA), West Virginia (WV), or New York (NY)

Multi-state licensure strongly preferred

Candidates who hold an active IMLC (Interstate Medical Licensure Compact) are encouraged to apply

Position Overview

Medix is partnering with a large national health plan to hire experienced Utilization Management Medical Directors for a remote contract opportunity supporting payer-side medical management operations.

This role is ideal for physicians with strong health plan utilization management experience who can quickly step into a high-volume review environment with minimal ramp-up.

Schedule

Full-time, 40 hours/week

Typical schedule: 8:30am–5:00pm

Flexible scheduling available

Fully Remote (work from anywhere in the U.S.)

2-day virtual training/bootcamp (8am–5pm EST)

Contract Details

6–12 month contract with potential contract-to-hire opportunity

Target start date: 6/1/2026

Key Responsibilities

Conduct utilization management reviews for medical necessity and appropriateness of care

Review escalated cases using established medical policy criteria

Participate in peer-to-peer discussions with providers as needed

Support prior authorizations, appeals, and grievance reviews

Ensure compliance with NCQA, CMS, URAC, and regulatory standards

Collaborate with clinical and operational leadership teams

Provide clinical guidance on complex medical necessity cases

Required Qualifications

MD or DO

Board Certified

Active unrestricted medical license

Active PA, WV, or NY license required OR active IMLC

Multiple years of payer-side / health plan Utilization Management experience as a Medical Director

Strong experience conducting utilization reviews in a health plan environment

Strong understanding of managed care operations and medical necessity criteria

Ability to work independently in a remote production-based environment

Preferred Experience

Medicare Advantage and/or Commercial plan experience

Appeals \& grievances review experience

Prior authorization review experience

Peer-to-peer review experience

Multi-state licensure preferred

Experience with InterQual, MCG, NCQA, CMS, and URAC standards

Preferred Backgrounds

Experience with organizations such as:

UnitedHealthcare / Optum

Aetna

Cigna / Evernorth

Humana

Elevance Health (Anthem)

Centene

Molina

Kaiser Permanente

Evolent

Carelon

Devoted Health

SCAN Health Plan

What Makes This Opportunity Stand Out

Fully remote opportunity with stable full-time hours

Fast-moving, high-impact payer-side environment

Opportunity to support national utilization management operations

Strong physician autonomy with collaborative leadership support

Ability to make a direct impact on care quality and medical management strategy

Ideal Candidate

We are seeking physicians who:

Have strong payer-side clinical judgment

Communicate effectively during peer-to-peer reviews

Thrive in production-based remote review environments

Understand medical necessity criteria and managed care workflows

Can efficiently manage high-volume case review workloads

Technology:

Epic experience preferred