Utilization Review Medical Director - Remote
Medical Review Institute of America (MRIoA) is a market leader in utilization management and clinical review solutions. We are seeking a full‑time, remote Medical Director (Physician Reviewer) to evaluate clinical service requests and determine compliance with patient health plan criteria and nationally accepted clinical guidelines. Peer‑to‑peer discussions with treating providers are part of the review process.
Responsibilities
Conduct coverage reviews using critical thinking and clinical expertise based on member benefits and national or proprietary coverage 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.
Benefits
Healthcare, vision, and dental insurance
401(k) retirement plan with generous company match
33 days of paid time off per year
Additional employee benefits
Schedule
40 hours per week, either 5 shifts of 8 hours or 4 shifts of 10 hours (after training)
Shifts scheduled between 6:00 a.m. – 7:00 p.m. 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
Medical Directors must be dedicated to assigned hours; part‑time positions are not available.
Equipment Requirements
All necessary computer equipment is provided.
Computers must be hard‑wired via Ethernet; Wi‑Fi is not permitted.
Requirements
Active MD/DO state licensure in any state.
Current board certification in Family Medicine or Internal Medicine.
Minimum 5 years of direct patient care experience post training, with most recent experience no less than 6 months ago.
Willingness to obtain up to 20 additional state licenses; MRIoA covers costs and CME requirements.
Clean background—no prior licensure issues, pending or prior malpractice cases, or legal issues.
Excellent verbal and written communication skills.
Excellent interpretation skills and divergent/creative thinking.
Additional Information
Must be fully dedicated to scheduled hours; caregiving responsibilities during work hours are not allowed. Malpractice insurance is not required; reviewers are covered under MRIoA’s Errors and Omissions policy.
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.
This company is a drug‑free workplace. All candidates are required to pass a background screen before beginning employment; a drug screen is required upon first day of employment. Employees must adhere to HIPAA regulations and company policies regarding confidentiality, privacy, and security of sensitive health information.