Utilization Review Medical Director

Who We Are - Motivated by Purpose. Powered by Clinical Expertise.

Founded in 1983, we’re a clinically-driven, tech-enabled utilization management company offering expert clinical reviews, regulatory guidance, and actionable insights to healthcare organizations.

Excellence starts with our people.

WE OFFER

• A competitive compensation package.
• Benefits include healthcare, vision and dental insurance, a generous 401k match, paid vacation, personal time, and holidays.
• Growth and training opportunities.
• A team atmosphere with fun events and prizes scheduled throughout the year.

Position Overview

Medical Review Institute of America (MRIoA) is experiencing continued growth and is seeking a full-time, remote Medical Director (Physician Reviewer) to join our team. For over 40 years, MRIoA has been a market leader in utilization management and clinical review solutions. Our Medical Directors play a critical role by applying their medical expertise to evaluate clinical service requests. Using professional judgment, Medical Directors determine whether requested services meet patient healthcare plan criteria and, in some cases, nationally accepted clinical guidelines. Reviews may involve peer-to-peer discussions with treating providers as needed.

Core Responsibilities

• Conduct coverage reviews using critical thinking and clinical expertise, based on individual patient/member benefits and national or proprietary coverage review policies.
• Interpret benefit language and policies to guide clinical coverage determinations.
• Document clinical review findings and outcomes in compliance with organizational, regulatory, and accreditation standards.
• Engage in peer-to-peer consultations with prescribing providers when appropriate.
• Collaborate and communicate effectively with fellow Medical Directors.

Schedule

• 40 hours per week, either 5 shifts of 8 hours, or 4 shifts of 10 hours (after training)
• Shifts scheduled between 6:00 AM - 7:00 PM MST (8:00 a.m. – 9:00 p.m. EST), with 2–3 weekend days per month
• Schedules provided at least 60 days in advance
• Note: This is not a flexible schedule; Medical Directors must be dedicated to their assigned hours. Part-time positions are not available.

To be eligible for this position, candidates must meet the following criteria:

• Hold an active, unencumbered state licensure as a Medical Doctor (MD/DO), any state. 
• Hold current board certification in either Family Medicine or Internal Medicine (no other board-certified specialty is currently needed).
• Possess a minimum of 5 years of direct patient care experience, with the most recent experience no less than 6 months ago (recent clinical care is essential).
• Be willing to obtain up to 20 additional state licenses (MRIoA covers the cost of licenses and CME requirements to maintain them).
• Have a clean background, without prior licensure issues, pending malpractice cases or legal issues.
• Possess excellent verbal and written communication skills.
• Excellent interpretation skills, divergent/creative thinking skills.

Equipment Requirements

• All necessary computer equipment is provided.
• For security, computers must be hard-wired via Ethernet (Wi-Fi is not permitted).

Additionally:

• Must be fully dedicated to the job during your scheduled hours. This is a busy position and does not allow for caregiving responsibilities during scheduled work hours.
• Malpractice insurance is not required, as physicians do not provide direct patient care. Reviewers are covered under MRIoA's Errors and Omissions policy.



Work Environment:

Ability to sit at a desk, utilize a computer, telephone, and other basic office equipment is required. This role is designed to be a remote position (work-from-home).

Diversity Statement:

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



Drug-Free Workplace:

This company is a drug-free workplace. All candidates are required to pass a Background Screen before beginning employment. All newly hired employees will take a Drug Screen, as well as agreeing to all necessary Compliance Regulations on their first day of employment.  Employees are required to adhere to all applicable HIPAA regulations and company policies and procedures regarding the confidentiality, privacy, and security of sensitive health information.

California Consumer Privacy Act (CCPA) Information (California Residents Only):

• Sensitive Personal Info: MRIoA may collect sensitive personal info such as real name, nickname or alias, postal address, telephone number, email address, Social Security number, signature, online identifier, Internet Protocol address, driver’s license number, or state identification card number, and passport number.
• Data Access and Correction: Applicants can access their data and request corrections. For questions and/or requests to edit, delete, or correct data, please email the Medical Review Institute at HR@mrioa.com.