The Judge Group
Job Title:
Medical Director – Utilization Management
Location:
Remote (Must reside in PA, NJ, or DE)
Employment Type:
Full-time Contract Duration:
One year assignment (possibly less depending on business needs) Schedule/Shift:
7.5 hours/day, Monday–Friday, 8:30 a.m.–5:00 p.m. Start Date:
January 5 Work Setting:
Remote
Overview
Our client is seeking an experienced Medical Director to support Utilization Management (UM) operations. This role involves conducting precertification reviews, peer-to-peer consultations, and ensuring compliance with CMS regulations and InterQual guidelines. The position is fully remote but requires residence in Pennsylvania, New Jersey, or Delaware.
Key Responsibilities Conduct Utilization Management reviews, including pre-certification, concurrent review, and retrospective review. Perform peer-to-peer discussions with ordering providers to clarify clinical information and determine medical necessity. Apply InterQual, CMS guidelines, and other evidence-based criteria to clinical determinations. Document decisions clearly and accurately in accordance with regulatory standards. Collaborate with clinical leadership, nurses, and quality teams to support UM operations. Participate in quality improvement initiatives and internal clinical meetings.
Required Qualifications Doctor of Medicine (MD) or Doctor of Osteopathy (DO) with active, unrestricted Pennsylvania medical license. Board Certified in Internal Medicine. Minimum 2+ years of Utilization Management experience, including pre-cert and peer review. Experience using InterQual criteria and CMS medical necessity guidelines. Must reside in PA, NJ, or DE. Cannot be concurrently employed or consulting with other health plans/payers.
Certifications/Licensure Active Pennsylvania medical license. Board Certification in Internal Medicine.
Compensation Competitive pay
How to Apply
Apply directly on LinkedIn.
Medical Director – Utilization Management
Location:
Remote (Must reside in PA, NJ, or DE)
Employment Type:
Full-time Contract Duration:
One year assignment (possibly less depending on business needs) Schedule/Shift:
7.5 hours/day, Monday–Friday, 8:30 a.m.–5:00 p.m. Start Date:
January 5 Work Setting:
Remote
Overview
Our client is seeking an experienced Medical Director to support Utilization Management (UM) operations. This role involves conducting precertification reviews, peer-to-peer consultations, and ensuring compliance with CMS regulations and InterQual guidelines. The position is fully remote but requires residence in Pennsylvania, New Jersey, or Delaware.
Key Responsibilities Conduct Utilization Management reviews, including pre-certification, concurrent review, and retrospective review. Perform peer-to-peer discussions with ordering providers to clarify clinical information and determine medical necessity. Apply InterQual, CMS guidelines, and other evidence-based criteria to clinical determinations. Document decisions clearly and accurately in accordance with regulatory standards. Collaborate with clinical leadership, nurses, and quality teams to support UM operations. Participate in quality improvement initiatives and internal clinical meetings.
Required Qualifications Doctor of Medicine (MD) or Doctor of Osteopathy (DO) with active, unrestricted Pennsylvania medical license. Board Certified in Internal Medicine. Minimum 2+ years of Utilization Management experience, including pre-cert and peer review. Experience using InterQual criteria and CMS medical necessity guidelines. Must reside in PA, NJ, or DE. Cannot be concurrently employed or consulting with other health plans/payers.
Certifications/Licensure Active Pennsylvania medical license. Board Certification in Internal Medicine.
Compensation Competitive pay
How to Apply
Apply directly on LinkedIn.