Medical Director

Highmark Health

Utilization Management Physician conducting electronic case reviews for Highmark Inc., ensuring compliance with clinical standards and regulations across multidisciplinary team collaborations.

Posted 5/14/2026full-timeRemote • Louisiana, Maryland, North Carolina, Pennsylvania, Washington • 🇺🇸 United StatesLead💰 $227,600 - $385,000 per yearWebsite

About the role

Key responsibilities & impact

Conduct electronic review of escalated cases against medical policy criteria
Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned
Compose clear and concise rationales for member and provider determination notifications
Participate as a member of the CMDM multidisciplinary team
Advise multidisciplinary team on cases that require physician expertise
Actively manage projects and/or participate on project teams that require a physician subject matter expert

Requirements

What you’ll need

Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
1 year in Medical Management in a Health Insurance Plan preferred
Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
Active medical state licensure required
Strong knowledge of managed care industry preferred

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Highmark Health Website LinkedIn All Job Openings 10,000+ employees Founded 1852 ⚕️ Healthcare Insurance 🤝 Non-profit 🌍 Social Impact 💰 $5M Grant on 2021-05 Healthcare Insurance
Non-profit
Social Impact Highmark Health is a healthcare company committed to reinventing the healthcare system and improving its services for everyone. The organization offers a broad range of career opportunities across various fields such as clinical care, technology, finance, and marketing. Highmark Health emphasizes diversity, equity, and inclusion in its workforce, creating a supportive environment for employees from all backgrounds. The company has been recognized for its commitment to disability inclusion, diversity, and military-friendly employment. As an independent licensee of the Blue Cross Blue Shield Association, Highmark Health strives to create remarkable healthcare experiences for its customers and employees alike. Medical Director Job not on LinkedIn 🔥 18 minutes ago ⚜️ Louisiana, North Carolina, +3 more states – Remote 💵 $227.6k - $385k / year ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director 🦅 H1B Visa Sponsor Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Conduct electronic review of escalated cases against medical policy criteria
Complete initial determination of cases, review of appeals and grievances, and other reviews as assigned
Compose clear and concise rationales for member and provider determination notifications
Participate as a member of the CMDM multidisciplinary team
Advise multidisciplinary team on cases that require physician expertise
Actively manage projects and/or participate on project teams that require a physician subject matter expert 🎯 Requirements
Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice)
1 year in Medical Management in a Health Insurance Plan preferred
Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association Specialty Certifying Boards
Active medical state licensure required
Strong knowledge of managed care industry preferred Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Prostate Field Medical Director – Non-MD 🔥 12 hours ago Pfizer 10,000+ employees Website LinkedIn All Job Openings Oncology Field Medical Director responsible for Prostate Cancer medical strategy in New England. Delivering therapeutic area expertise and engaging with medical customer segments in a remote setting. 🇺🇸 United States – Remote 💵 $176.6k - $294.3k / year 💰 Post-IPO Debt on 2023-05 ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director 🦅 H1B Visa Sponsor Prostate Field Medical Director – Non-MD 🔥 18 hours ago Pfizer 10,000+ employees Website LinkedIn All Job Openings Oncology Field Medical Director providing therapeutic expertise for Prostate Cancer in New England territory. Developing strategies and providing medical content for health care professionals across assigned states. 🇺🇸 United States – Remote 💵 $176.6k - $294.3k / year 💰 Post-IPO Debt on 2023-05 ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director 🦅 H1B Visa Sponsor Medical Director, Clinical Trial Physician – Neurology 🔥 19 hours ago Thermo Fisher Scientific 10,000+ employees 🧬 Biotechnology 💊 Pharmaceuticals 🔬 Science Website LinkedIn All Job Openings Medical Director/Clinical Trial Physician at Thermo Fisher Scientific conducting groundbreaking research for clinical trials. Leading a study team and ensuring medical compliance in a fully remote role. 🇺🇸 United States – Remote ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director 🦅 H1B Visa Sponsor Associate Medical Director, Value-Based Care 🔥 21 hours ago Urrly 1 - 10 🎯 Recruiter ⚕️ Healthcare Insurance 🤖 Artificial Intelligence Website LinkedIn All Job Openings Associate Medical Director leading and improving value-based care programs across home-based and virtual care settings. Collaborating with teams to enhance workflows, care gap closure, and member outcomes. 🇺🇸 United States – Remote 💵 $250k - $275k / year ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director Medical Director 🔥 22 hours ago ICON plc 10,000+ employees 💊 Pharmaceuticals 🧬 Biotechnology ⚕️ Healthcare Insurance Website LinkedIn All Job Openings Medical Director at ICON focusing on patient safety strategy and evaluating safety data in therapeutic programs. Leading medical safety initiatives and collaborating with stakeholders in the pharmaceutical industry. 🇺🇸 United States – Remote ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director View More Medical Director Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

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Hard Skills & Tools

clinical caremedical managementcase determinationappeals reviewgrievance reviewproject managementmedical policy criteria

Soft Skills

communicationteam collaborationadvisory skillsproject participation

Certifications

Medical Doctor (MD)Doctor of Osteopathic Medicine (DO)Board Certification