Medical Director-Medicaid (ABH VA)

This role supports clinical priorities focused on quality, patient-centered outcomes, and effective care delivery. You will collaborate with clinical leaders, operational teams, and cross-functional stakeholders to improve standards, workflows, and execution, strengthening care quality, team performance, and measurable outcomes within a healthcare environment.

Location: Remote - US based candidates only, no visa sponsorship available.

Responsibilities

• Conduct utilization management and medical necessity reviews
• Determine prior authorization and precertification requirements
• Perform concurrent reviews for inpatient and outpatient services
• Review acute and post-acute care cases
• Engage in peer-to-peer consultations with treating providers
• Perform pharmacy reviews and first-level appeal determinations
• Collaborate with multidisciplinary clinical and operational teams

Qualifications

• M.D. or D.O. degree with active Board Certification in an ABMS- or AOA-recognized specialty
• 5+ years of post-residency clinical practice with direct patient care experience
• Active, unrestricted Virginia medical license required
• Capacity to obtain and maintain medical licenses in Maryland, New Jersey, New York, and Pennsylvania

Pay

$174,070 – $374,920 annually

Benefits

• Comprehensive medical, dental, and vision coverage
• Paid time off and retirement savings options
• Wellness programs and additional resources for employee well-being
• Eligibility for the company bonus and equity award program