Medical Director (Active PA, NY, WV License)

Job Summary

Seeking a dedicated Medical Director (Active PA, NY, WV License) to manage utilization management responsibilities in a full-time remote capacity, ensuring compliance with clinical standards and conducting reviews of medical necessity and appropriateness.

Key responsibilities

• Conduct electronic reviews of escalated cases and determine medical necessity through peer discussions
• Complete initial case determinations and manage appeals while adhering to compliance standards
• Participate in multidisciplinary team activities and contribute to protocol development for consistency in reviews

Required qualifications

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
• Board Certification in a specialty recognized by relevant medical boards
• Active medical state licensure in PA, NY, or WV
• Minimum of 5 years in clinical direct patient care
• Experience in managed care and utilization management