Medical Director - PI, Claims

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

About the Role

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. The position offers the opportunity to strengthen care quality, team performance, and measurable outcomes within a healthcare environment.

Responsibilities

• Provide medical interpretations and authorizations for healthcare services.
• Collaborate with team members and departments.
• Conduct clinical reviews of records to determine service agreement with guidelines.
• Communicate decisions to internal associates and engage in necessary discussions.
• Participate in care management and conflict resolution when needed.
• Guide utilization management within assigned patient populations.
• Contribute to project teams or organizational committees.

Qualifications

• MD or DO degree.
• 5+ years of direct clinical patient care experience post-residency or fellowship, especially with Medicare populations.
• Current and ongoing Board Certification.
• Current and unrestricted medical license; willingness to obtain additional licenses.
• No current sanctions from government organizations; must pass credentialing.
• Evidence of analytic and interpretation skills, particularly in quality and utilization management.
• Knowledge of the managed care industry and relevant products.

Pay

$223,800 – $313,100 annually.

Benefits

• Medical, dental, and vision coverage.
• 401(k) retirement savings plan.
• Paid time off including personal holidays and parental leave.
• Short-term and long-term disability insurance.
• Life insurance and other opportunities for well-being support.