Medical Director, Prior Authorization

About the role

This role will support 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.

Location

Remote - US based candidates only, no visa sponsorship available

Compensation

$200,000 – $250,000 annually

Responsibilities

• Conduct case reviews to ensure care appropriateness and adherence to CMS guidelines
• Engage in peer-to-peer discussions with providers regarding prior authorizations and clinical documentation
• Assist in training clinical teams on compliance and documentation related to CMS guidelines
• Offer clinical improvement recommendations based on record reviews and data analysis
• Participate in quality improvement initiatives to enhance care delivery and performance metrics
• Maintain up-to-date records of clinical reviews and quality enhancement efforts

Qualifications

• Board-certified clinician (MD or DO) with a specialty recognized by the American Board of Medical Specialties; preference for anesthesiology or pain management fellowship
• Minimum of 3 years board certification experience
• Active, unrestricted medical license in at least one U.S. jurisdiction; must not be excluded from Medicare/Medicaid
• Preference for Washington state license or willingness to obtain one

Preferred experience

• Utilization management

Benefits

• Remote work with a predictable full-time schedule
• Comprehensive training and education program provided
• Opportunities for career growth within the organization
• Medical, dental, and vision benefits along with 401K options
• Generous paid time off and holidays, plus long-term disability and life insurance
• Allotment for continuing medical education (CME) and license renewals