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Medical Director
Medical DirectorThe Judge Group • Philadelphia, PA, United States
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Medical Director

Medical Director

The Judge Group • Philadelphia, PA, United States
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Medical Director – Utilization Management

Location : Remote (must reside in PA, NJ, or DE) Start Date : January 5 Assignment Length : 1–2 years Schedule : Full-time, Monday–Friday, 8 : 30 AM–5 : 00 PM (7.5 hrs / day) Compensation : $150 / hr

Position Overview

We are seeking an experienced Medical Director to support Utilization Management (UM) operations. This role involves conducting medical necessity reviews, precertification, and peer-to-peer consultations to ensure compliance with CMS regulations and evidence-based guidelines. The position is fully remote but requires residence in Pennsylvania, New Jersey, or Delaware.

Key Responsibilities

  • Conduct UM reviews, including pre-certification, concurrent, and retrospective reviews.
  • Perform peer-to-peer discussions with ordering providers to clarify clinical information.
  • Apply InterQual and CMS guidelines to medical necessity determinations.
  • Document decisions accurately in accordance with regulatory standards.
  • Collaborate with clinical leadership and quality teams to support UM operations.
  • Participate in quality improvement initiatives and internal clinical meetings.

Required Qualifications

  • MD or DO with active, unrestricted Pennsylvania medical license
  • Board Certified in Internal Medicine
  • Minimum 2+ years of Utilization Management experience (pre-certification and peer review).
  • Demonstrated expertise with InterQual criteria and CMS medical necessity guidelines
  • Must reside in PA, NJ, or DE
  • Cannot be concurrently employed or consulting with another health plan / payer.
  • Candidates currently employed at Jefferson or Penn are not eligible.
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