Medical Director (MD or DO)

Physical Health Medical Director

Location: Primarily Remote (North Carolina preferred)
Organization Type: Healthcare Managed Care Organization

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Role Overview

The Physical Health Medical Director provides clinical leadership and oversight for physical health utilization management. This role ensures high-quality, compliant, and defensible medical review decisions while collaborating closely with medical, behavioral health, and care management teams. The position supports clinical quality initiatives, regulatory compliance, and operational excellence across utilization management functions.

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Requirements

• MD or DO from an accredited medical school
• Board Certification in Family Medicine (ABFM) or Internal Medicine (ABIM)
• Active, unrestricted North Carolina medical license
• Minimum of 2+ years of managed care and utilization management experience

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Job Duties

• Review and authorize physical health services and levels of care across inpatient and outpatient settings
• Conduct initial, concurrent, and appeal utilization management reviews using medical necessity criteria
• Ensure compliance with regulatory, accreditation, and internal medical management standards
• Provide clinical guidance and leadership to utilization management and care management teams
• Participate in clinical and operational committees, including quality and care transition reviews
• Support consistent, timely, and well-documented medical decision-making within UM platforms
• Collaborate across departments to address complex cases and improve care delivery processes

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Additional Information

• Schedule: Full-time, Monday-Friday (8:00 AM – 5:15 PM); occasional evenings, weekends, or holidays may be required
• Pay Range: $215,000 – $269,000/annually