Medical Director – Utilization Review

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Medical Review Institute of America, LLC

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Healthcare Insurance • SaaS • Data

Medical Review Institute of America, LLC is a company specializing in clinical and utilization review services. They offer a comprehensive suite of data-driven solutions, including prior authorization optimization, second opinions, and specialty drug reviews, aimed at ensuring the right care is delivered at the right time and in the right place. MRIoA provides services to health plans, pharmacy benefit managers, government entities, and self-insured employers, among others. They leverage technology and a network of professionals to streamline clinical decisions, enhance provider performance, and ensure compliance with regulatory requirements across all 50 states. Their tools and platforms are designed to optimize clinical reviews, reduce costs, and improve patient outcomes through evidence-based care pathways and telehealth solutions.

501 - 1000 employees

Founded 1983

⚕️ Healthcare Insurance

☁️ SaaS

📋 Description

• As a Medical Director, you will use your clinical expertise to evaluate clinical service requests, interpret benefit language and medical policies, and render coverage determinations. • Conduct clinical coverage reviews using member benefits and established clinical guidelines. • Interpret benefit language and policies to support review determinations. • Document review findings in accordance with regulatory, accreditation, and internal standards. • Engage in peer-to-peer discussions with treating providers when needed. • Collaborate with a nationwide team of Medical Directors.

🎯 Requirements

• MD or DO degree, with current board certification in Family Medicine or Internal Medicine. • 5 years of recent direct patient care experience, with 3 full years of in-patient hospital experience in an acute care setting - strongly preferred. • Be highly adept with computers, with strong computer literacy. • Be willing to obtain up to 20 additional state licenses (MRIoA will manage and cover the cost of licenses and CME requirements to maintain them). • Clean background, without any prior licensure issues or pending/prior malpractice (background or malpractice issues can delay the process of obtaining additional licenses). • Must have passed each component of the USMLE, COMLEX-USA, or equivalent predecessor exam accepted by the state medical board (such as the FLEX or NBME) in no more than three attempts for each component. • You must be fully committed to the job during your scheduled hours. This position does not allow for any caregiving or other responsibilities during your scheduled work hours.

🏖️ Benefits

• Work-from-home, full-time salaried position • Comprehensive benefits package, including: Medical, dental, and vision insurance • 401(k) with generous company match • 35 days of PTO per year • All computer equipment provided • Long-standing, stable organization with 43+ years of industry leadership • Schedule: 40 hours per week, Shift options available