Medical Director

Medical Director – Utilization Management Location: Remote (must reside in PA, NJ, or DE) Start Date: January 5 Assignment Length: 1–2 years Schedule: Full-time, Monday–Friday, 8:30 AM–5:00 PM (7.5 hrs/day) Compensation: $130-145/hr Position Overview We are seeking an experienced Medical Director to support Utilization Management (UM) operations. This role involves conducting medical necessity reviews, precertification, and peer-to-peer consultations to ensure compliance with CMS regulations and evidence-based guidelines. The position is fully remote but requires residence in Pennsylvania, New Jersey, or Delaware. Key Responsibilities Conduct UM reviews, including pre-certification, concurrent, and retrospective reviews. Perform peer-to-peer discussions with ordering providers to clarify clinical information. Apply InterQual and CMS guidelines to medical necessity determinations. Document decisions accurately in accordance with regulatory standards. Collaborate with clinical leadership and quality teams to support UM operations. Participate in quality improvement initiatives and internal clinical meetings. Required Qualifications MD or DO with active, unrestricted Pennsylvania medical license . Board Certified in Internal Medicine . Minimum 2+ years of Utilization Management experience (pre-certification and peer review). Demonstrated expertise with InterQual criteria and CMS medical necessity guidelines . Must reside in PA, NJ, or DE . Cannot be concurrently employed or consulting with another health plan/payer. Candidates currently employed at Jefferson or Penn are not eligible.

Created: 2026-03-04