Group Health Medical Director

Dane Street

Physician Reviewer in Group Health division performing utilization reviews efficiently and accurately. Delivering timely clinical rationales and ensuring compliance in a fast-paced environment.

Posted 5/5/2026full-timeRemote • 🇺🇸 United StatesLeadWebsite

About the role

Key responsibilities & impact

Perform utilization review for:
- Preauthorization requests
- Appeals (first and second level)
- Independent external reviews
- DRG validation and clinical review
- Benefit and coverage determinations
- Experimental/Investigational (E/I) review
Apply evidence-based criteria and guidelines, including:
- InterQual
- MCG
- CMS guidelines (including 2-Midnight Rule)
- LCD/NCD
- Client-specific policies
Produce clear, concise, and defensible clinical rationales
Maintain high accuracy and consistency across determinations
Meet or exceed turnaround time (TAT) expectations, including urgent cases
Participate in peer-to-peer discussions as needed
Collaborate with QA and operational teams to ensure quality and compliance
Reviews may be conducted within internal systems or client-specific platforms, depending on assignment and client requirements

Requirements

What you’ll need

MD or DO, board-certified in Internal Medicine, Family Medicine, or similar
Active, unrestricted medical license
Prior utilization review experience, preferably in a health plan or IRO environment
Familiarity with InterQual, MCG, and CMS guidelines
Strong clinical judgment and documentation skills
Ability to work independently in a high-throughput environment

Benefits

Comp & perks

Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

utilization reviewpreauthorization requestsappealsindependent external reviewsDRG validationclinical reviewbenefit determinationscoverage determinationsexperimental reviewevidence-based criteria

Soft Skills

clinical judgmentdocumentation skillsindependent workhigh-throughput environmentcollaborationcommunicationaccuracyconsistencydefensible clinical rationalespeer-to-peer discussions

Certifications

MDDOboard-certified in Internal Medicineboard-certified in Family Medicineactive medical license