Growth Opportunity - Medical Director (Utilization Review)

Medical Director (Physician Utilization Review) – Remote | Full-Time

Join a national leader in utilization management and clinical review services. MRIoA has been providing evidence-based review solutions for over 43 years, and we are seeking a full-time, remote Medical Director (Physician Reviewer) to support our growing team.

About the Role

As a Medical Director, you will use your clinical expertise to evaluate clinical service requests, interpret benefit language and medical policies, and render coverage determinations. You may also participate in peer-to-peer conversations with treating providers. This is a fully remote, salaried position with a strong emphasis on clinical judgment, documentation accuracy, and collaboration with fellow Medical Directors.

Key Responsibilities

• Conduct clinical coverage reviews using member benefits and established clinical guidelines.
• Interpret benefit language and policies to support review determinations.
• Document review findings in accordance with regulatory, accreditation, and internal standards.
• Engage in peer-to-peer discussions with treating providers when needed.
• Collaborate with a nationwide team of Medical Directors.

What We Offer

• Work-from-home, full-time salaried position
• Comprehensive benefits package, including:
• Medical, dental, and vision insurance
• 401(k) with generous company match
• 35 days of PTO per year
• All computer equipment provided
• Long-standing, stable organization with 43+ years of industry leadership

Schedule

• 40 hours per week:
• Five 8-hour shifts, or
• Four 10-hour shifts (available after training)
• Shifts fall between 6:00 a.m.–7:00 p.m. MST (8:00 a.m.–9:00 p.m. EST)
• Includes 2–3 weekend days per month
• Schedules are released 60 days in advance
• Please note: schedules are fixed; part-time options are not available
• Internet must be hard-wired via Ethernet for security (Wi-Fi not permitted)

To qualify for this position, you must meet the following requirements:

•            MD or DO degree, with current board certification in Family Medicine or Internal Medicine.

•            5 years of recent direct patient care experience, with 3 full years of in-patient hospital experience in an acute care setting - strongly preferred.

•            Be highly adept with computers, with strong computer literacy.

•            Be willing to obtain up to 20 additional state licenses (MRIoA will manage and cover the cost of licenses and CME requirements to maintain them).

•            Clean background, without any prior licensure issues or pending/prior malpractice (background or malpractice issues can delay the process of obtaining additional licenses).

•            Must have passed each component of the USMLE, COMLEX-USA, or equivalent predecessor exam accepted by the state medical board (such as the FLEX or NBME) in no more than three attempts for each component.

•            You must be fully committed to the job during your scheduled hours. This position does not allow for any caregiving or other responsibilities during your scheduled work hours.

•   You must reside and work within the United States.

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. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment. 

For California Residents - California Consumer Privacy Act (CCPA) Information:

Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.

Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com.