Medical Director – Utilization Management

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Medical Review Institute of America, LLC

WebsiteLinkedInAll Job Openings

501 - 1000 employees

Founded 1983

⚕️ Healthcare Insurance

☁️ SaaS

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.

📋 Description

• Perform utilization management case reviews. • Maintain productivity score per company standard. • Maintain annual quality score per company standard. • Complete annual inter-rater reliability testing. • Train across all queues as requested by MRIoA leadership. • Complete all client specific training as requested by MRIoA leadership. • Maintain up-to-date records of case completion if required. • Consistently show willingness to take cases as requested. • Demonstrate respect in interactions across the company. • Consistently submit scheduling requests at least three months in advance. • Consistently work scheduled hours. • Provide ideas for promotion and growth of the company as requested (i.e. contribute to the vision of the company). • Respond appropriately and in a timely manner to licensing/CME requests from the Senior Medical Directors, Vice President of Medical Affairs, or Chief Medical Officer and/or administrative team. • Actively participate in the MRIoA evaluation process (both company and individual). • Participate in all company meetings and committees as requested. • Complete other duties as requested or approved by the CEO and/or chief medical officer. • Thorough understanding of the Company’s clients, products, departments, workflows, and applicable regulatory requirements and accreditation standards

🎯 Requirements

• Minimum of five years’ full-time equivalent experience providing direct clinical care to patients • Minimum of five years’ experience administering utilization management and peer review programs preferred • Credentialed and privileged by the Company's Credentialing Committee • Obtain additional state licensure as required for the position • Education: MD/DO degree • Current, unrestricted medical license as required for clinical practice in a state of the United States • Board certification by a medical specialty board approved by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA) or other board recognized by URAC preferred

🏖️ Benefits

• healthcare, vision, and dental insurance • A generous 401(k) match • Paid vacation, PTO, and holidays • Growth and training opportunities • An award-winning remote work environment