Utilization Management Medical Director - Remote

For our client, we are seeking a Utilization Management Medical Director - Remote to join the team of a leader in the Healthcare space. This leadership role will guide medical necessity and coverage review activities that support accurate, timely benefit determinations for members. The position partners closely with requesting providers, internal clinical teams, and network and non-network physicians to ensure reviews are clinically sound, well documented, and aligned with policy requirements. This is a remote opportunity with broad national reach, offering the chance to influence utilization management processes and support high-quality care decisions. Location: Remote - US based candidates only, no visa sponsorship available Compensation: $248,500 – $373,000 annually Responsibilities Conduct coverage reviews based on member plan benefits and policies Document clinical review findings and outcomes according to regulations Engage in peer-to-peer discussions with requesting providers Interpret benefit language during clinical coverage reviews Participate in daily clinical rounds as needed Collaborate with network and non-network providers for accurate benefit determinations Communicate with internal partners regarding clinical processes Qualifications M.D. or D.O. degree required Current board certification through ABMS or AOA Active unrestricted medical practice license 5+ years of post-residency clinical practice experience Strong understanding of Evidence Based Medicine (EBM) Proficient in MS Word, Outlook, and Excel Benefits Comprehensive benefits package Incentive and recognition programs Equity stock purchase 401k contribution options Remote work flexibility from anywhere in the U.S. Our client is an equal opportunity employer. We encourage you to apply even if you don’t meet every qualification—your background could be exactly what this team needs.