Medical Director
HJ Staffing
full-time
Posted on:
Location Type: Remote
Location: New Jersey • United States
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Job Level
About the role
- Conduct clinical reviews for inpatient admissions and post-acute settings using evidence-based guidelines (MCG, InterQual) and CMS criteria
- Serve as the primary physician reviewer for escalated or complex cases requiring high-level medical judgment
- Engage in peer-to-peer discussions with attending physicians to clarify clinical documentation and support the appropriate level of care
- Partner with care management teams to identify utilization trends and develop interventions to reduce unnecessary admissions or extended stays
- Ensure all decisions are documented in strict accordance with NCQA, CMS, and organizational standards
- Contribute expertise to initiatives focused on readmission reduction and transitions of care
Requirements
- M.D. or D.O. in good standing in your state of residence
- Minimum of 5 years of clinical experience
- At least 3 years in a Utilization Management or medical leadership role within a health plan setting
- Strong experience with Medicare Advantage case reviews and CMS coverage criteria
- Preferred: MPH, MBA, or MHA; Certification by the ABQAURP
Benefits
- Health insurance
- Paid time off
- Professional development opportunities
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
clinical reviewsevidence-based guidelinesMedicare Advantage case reviewsCMS criteriautilization managementmedical judgmentclinical documentationreadmission reductiontransitions of care
Soft Skills
peer-to-peer discussionscollaborationcommunicationleadershipproblem-solving
Certifications
M.D.D.O.MPHMBAMHAABQAURP certification