Clinical Operations Full-time Remote / National
We are seeking a Physician Medical Director to join our physician-led team. In this role, you will provide high-level clinical advocacy to hospitals nationwide, working directly with payer medical directors to overturn denials and ensure appropriate patient status determinations.
What You Will Do
Conduct forensic clinical reviews of patient records and status determinations
Lead Peer-to-Peer (P2P) consultations with payer medical directors
Advocate for hospitals by challenging inappropriate denials using evidence-based criteria
Draft comprehensive Clinical Advocacy Notes for legal and compliance records
Collaborate with utilization management teams to optimize clinical workflows
Impact
Your work will directly contribute to raising hospital admission approval rates and recovering revenue lost to inappropriate payer denials. This is a role where clinical expertise meets advocacy at scale.
Requirements & Qualifications
- Board certification in a medical specialty (Medicine, Surgery, Cardiology, Pediatrics, etc.)
- Minimum 5 years of clinical practice experience
- Strong working knowledge of Milliman, InterQual , and national coverage criteria
- Excellent communication and negotiation skills
- Experience with utilization management or payer relations preferred
- Licensed to practice medicine in at least one U.S. state
Physician Medical Director in northern at Unknown Company
This position is listed as full time and able to be worked remotely.