PA Licensed Medical Director

Job Summary

PA Licensed Medical Director, seeking a full-time, contract-to-hire professional with payer-side utilization management experience to perform medical necessity reviews and support clinical projects in a remote setting.

Key Responsibilities

• Review escalated cases against medical policy criteria to determine medical necessity
• Complete initial determinations, appeals, and grievance reviews while conducting peer-to-peer calls as needed
• Participate in multidisciplinary team discussions and support guideline development

Required Qualifications

• MD or DO degree
• Board Certified (ABMS or AOA)
• 5+ years of direct patient care experience
• Active, unrestricted license in PA, NY, or WV
• Must have payer-side utilization management experience