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Medical Director
Job in
Allentown, Lehigh County, Pennsylvania, 18103, USA
Listed on 2026-02-12
Listing for:
The Judge Group
Full Time
position Listed on 2026-02-12
Job specializations:
-
Doctor/Physician
Medical Doctor, Healthcare Consultant, Emergency Medicine Physician, Internal Medicine Physician
Job Description & How to Apply Below
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: $130-145/hr
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 Inter Qual 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.
- 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 Inter Qual 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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