Remote Medical Director jobs

About the Medical Director role

What the work looks like

• Review prior authorization requests and appeals against clinical guidelines and issue coverage determinations.
• Hold peer-to-peer calls with treating physicians to discuss a denied or pended request.
• Write and update clinical policies, protocols and care pathways as evidence and regulation change.
• Supervise and audit physicians, nurse practitioners and nurse reviewers, and handle quality concerns.
• Represent the clinical view in meetings on quality measures, compliance, accreditation and new programs.

What employers ask for

• MD or DO with an unrestricted state license
• Board certification in a relevant specialty
• Several years of clinical practice
• Utilization management criteria such as InterQual or MCG
• Quality improvement and regulatory knowledge
• Experience leading clinicians

Doing this job remotely

Case review, policy work and telehealth oversight are done by phone and computer, which is why insurers and virtual care companies hire medical directors remotely. An active medical license is required, and some positions ask for licenses in particular states or several states. Review work carries turnaround deadlines set by regulation, and facility-based director roles are not remote at all.

Where it comes from and where it leads

Medical directors are practicing physicians first, usually moving into leadership or utilization review after years of patient care, sometimes while keeping part-time clinical work. The next steps are senior medical director, vice president of medical affairs and chief medical officer.