Assistant Medical Director - Utilization Review

Location: Remote within the listed U.S. hiring states; work 5 days per week, including 1–2 Saturdays per month, during Pacific Standard Time hours.

Salary: $214,500–$386,100 per year.

Company

hirify.global is a health plan focused on improving healthcare outcomes and member experience.

What you will do

• Make final coverage determinations based on medical necessity, medical policy, member contracts, exclusions, and network structure.
• Review pre-service, post-service, concurrent facility-based care, and transitions between levels of care.
• Support claims decisions involving level of care, pricing, complexity, disability status, and procedure payment determinations.
• Conduct peer-to-peer discussions with external physicians and providers and collect additional clinical information.
• Advise clinical teams supporting disease management, case management, and care transition programs.
• Develop and approve medical review criteria, support clinician education, and participate in inter-rater review.

Requirements

• MD or DO degree and physician license.
• Unrestricted Washington state licensure, an administrative license, or the ability to obtain one within 90 days.
• At least five years of clinical experience.
• Board certification from an accepted recognized medical or osteopathic board is preferred.
• Experience with medical necessity and clinical reviews in a health plan setting is preferred.
• Familiarity with MCG, InterQual, clinical pathways, CPT, ICD, HCPCS, and RBRVS pricing concepts is preferred.

Culture & Benefits

• Medical, vision, and dental coverage with low employee premiums.
• Life and disability insurance, 401(k) employer match, and a pension plan vested after three years.
• Paid time off, wellness resources, counseling, and stress management programs.
• Tuition assistance for undergraduate and graduate education.
• Employee recognition programs and continuing education support.