Pennsylvania Licensed Medical Director

Job Summary

To support high-volume medical necessity reviews, the remote contract Physician Medical Director will review escalated cases, complete initial determinations, and conduct peer-to-peer calls while working 40 hours per week in a compliance-driven environment.

Key responsibilities

• Review escalated cases against medical policy criteria to determine medical necessity
• Complete initial determinations, appeals, and grievance reviews
• Write clear, compliant clinical rationales and participate in multidisciplinary team discussions

Required qualifications

• MD or DO with board certification (ABMS or AOA)
• 5+ years of direct patient care experience
• Active, unrestricted license in PA, NY, or WV
• Knowledge of managed care and utilization management
• Payer-side utilization management experience required