Utilization Review Medical Director - Remote

Description

Medical Director (Physician Reviewer)

Full-Time | Remote (U.S.-Based)

Medical Review Institute of America (MRIoA) is a nationally recognized leader in utilization management and clinical review services, delivering evidence-based solutions for more than 43 years. We are currently seeking a full-time Medical Director (Physician Reviewer) to join our growing, fully remote team. (Contact Medical.Opportunities@mrioa.com for PRN opportunities)

Position Overview

In this role, you will apply your clinical expertise to evaluate requests for medical services, interpret benefit language and medical policies, and make sound coverage determinations. You may also engage in peer-to-peer discussions with treating providers. This position emphasizes independent clinical judgment, thorough 

Core Responsibilities

• Conduct coverage reviews using critical thinking and clinical expertise, based on individual patient/member benefits and national or proprietary coverage review policies.
• Interpret benefit language and policies to guide clinical coverage determinations.
• Document clinical review findings and outcomes in compliance with organizational, regulatory, and accreditation standards.
• Engage in peer-to-peer consultations with prescribing providers when appropriate.
• Collaborate and communicate effectively with fellow Medical Directors.

Schedule

• 40 hours per week, either 5 shifts of 8 hours, or 4 shifts of 10 hours (after training)
• Shifts scheduled between 6:00 AM - 7:00 PM MST (8:00 a.m. – 9:00 p.m. EST), with 2–3 weekend days per month
• Schedules provided at least 60 days in advance
• Note: This is not a flexible schedule; Medical Directors must be dedicated to their assigned hours.

Compensation & Additional Information

Permanent Starting Salary: The starting salary for this position is $240,000 annually and includes a full benefits package. Candidates with previous leadership or Utilization Review experience may qualify for a higher starting salary.

Requirements

To be eligible for this position, candidates must meet the following criteria:

• Hold an active, unencumbered state licensure as a Medical Doctor (MD/DO), any state. 
• Hold current board certification in either Family Medicine or Internal Medicine (no other board-certified specialty is currently needed).
• Possess a minimum of 5 years of direct patient care experience, with the most recent experience no less than 6 months ago (recent clinical care is essential).
• Be willing to obtain up to 20 additional state licenses (MRIoA covers the cost of licenses and CME requirements to maintain them).
• Have a clean background, without prior licensure issues, pending malpractice cases or legal issues.
• Possess excellent verbal and written communication skills.
• Excellent interpretation skills, divergent/creative thinking skills.

Equipment Requirements

• All necessary computer equipment is provided.
• A hard-wired Ethernet connection is preferred, but a reliable Wi-Fi connection is also acceptable

Additionally:

• Must be fully dedicated to the job during your scheduled hours. This is a busy position and does not allow for caregiving responsibilities during scheduled work hours.
• Malpractice insurance is not required, as physicians do not provide direct patient care. Reviewers are covered under MRIoA's Errors and Omissions policy.



Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).

Diversity Statement:

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



Drug-Free Workplace:

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary