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:

$150/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.