Physician Utilization Review Medical Director

Physician Utilization Review Medical Director

Medical Review Institute of America (MRIoA) is a nationally recognized leader in utilization management and clinical review services, delivering evidence-based solutions for more than 43 years. We are currently seeking a full-time Associate Medical Director (Physician Advisor) to join our growing, fully remote team.

Position Overview

In this role, you will apply your clinical expertise to evaluate requests for medical services, interpret benefit language and medical policies, and make sound coverage determinations. You may also engage in peer-to-peer discussions with treating providers. This position emphasizes independent clinical judgment, thorough documentation, and collaboration with a nationwide team of Medical Directors.

Core Responsibilities

• Perform clinical coverage reviews using member benefits, medical policies, and established clinical guidelines
• Interpret benefit language to support accurate and compliant determinations
• Document review outcomes in alignment with regulatory, accreditation, and internal standards
• Participate in peer-to-peer discussions with treating providers as needed
• Collaboration with Medical Directors across multiple specialties and regions

Compensation & Benefits

• Fully remote, full-time salaried position
• Comprehensive benefits package, including:
• Medical, dental, and vision insurance
• 401(k) with generous employer match
• 35 days of paid time off annually
• All required computer equipment provided
• Employment with a stable, well-established organization with long-term industry leadership

Work Schedule

• 40 hours per week
• Five 8-hour shifts, or Four 10-hour shifts (available after training)
• Shifts scheduled between 6:00 a.m.–7:00 p.m. MST (8:00 a.m.–9:00 p.m. EST)
• Includes 2–3 weekend shifts per month
• Schedules are released 60 days in advance
• Schedules are fixed; part-time arrangements are not available

Required Qualifications

• MD or DO degree with current board certification in Family Medicine or Internal Medicine - REQUIRED
• Minimum of 5 years of recent direct patient care experience
• At least 3 years of inpatient hospital experience in an acute care setting is strongly preferred
• High level of computer proficiency and comfort with multiple systems
• Willing and able to obtain up to 20 additional state medical licenses
• A hard-wired Ethernet connection is preferred, but a reliable Wi-Fi connection is also acceptable.
• MRIoA manages and covers all licensing and CME costs
• Clean background with no prior or pending licensure or malpractice issues (Such issues may delay multi-state licensure)
• Each component of the USMLE, COMLEX-USA, or equivalent predecessor exam must have been passed in no more than three attempts per component
• Ability to be fully dedicated during scheduled work hours; Caregiving or other responsibilities during work hours are not permitted
• Must reside and work within the United States

Equal Employment Opportunity

MRIoA is committed to creating a diverse and inclusive workplace. 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.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.

For California Residents - California Consumer Privacy Act (CCPA) Information:

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.

Key skills/competency

• Physician Utilization Review
• Medical Director
• Clinical Review
• Utilization Management
• Medical Policies
• Benefit Interpretation
• Peer-to-Peer Discussion
• Clinical Judgment
• Documentation
• Board Certification