Medical Director

Location: Remote, work from home in Pennsylvania, United States

Company

hirify.global provides health insurance and medical management services focused on member care and utilization review.

What you will do

• Review escalated cases, appeals, grievances, and other medical management requests against medical policy criteria.
• Determine the medical necessity and appropriateness of requested treatment and services.
• Conduct telephonic peer-to-peer discussions and prepare clear rationales for member and provider notifications.
• Advise multidisciplinary case and disease management teams on high-risk cases requiring physician expertise.
• Participate in protocol and guideline development, huddles, grand rounds, and physician-led project teams.
• Ensure utilization management activities comply with NCQA, URAC, CMS, DOH, DOL, and community standards of care.

Requirements

• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree.
• At least 5 years of clinical or direct patient care experience in a hospital, outpatient, or private practice setting.
• At least 1 year of medical management experience in a health insurance plan and strong knowledge of managed care.
• Board certification in a specialty recognized by the American Board of Medical Specialties or American Osteopathic Association Specialty Certifying Boards.
• Active medical state licensure; additional state licenses may be required based on business needs.
• Must work remotely from Pennsylvania, United States.

Nice to have

• Master's degree in Business Administration, Management, or Public Health.

Culture & Benefits

• Remote, work-at-home position with occasional travel requirements of 0%–25%.
• Regular collaboration with multidisciplinary case and disease management teams.
• Work includes physician-led projects supporting improvements in member care.
• Position requires compliance with HIPAA, privacy, information security, and business conduct standards.