Medical Director, Utilization Management (Medtech)

TL;DR

Medical Director, Utilization Management (Medtech): Evaluating outpatient referrals and inpatient admissions for medical appropriateness with an accent on Medicare coverage determinations and clinical guidelines. Focus on reviewing authorization requests, conducting peer-to-peer discussions, and mentoring clinical staff to optimize member care.

Location: Remote (Must be based in the USA)

Salary: $280,000 - $300,000

Company

hirify.global is reinventing health insurance by combining data with human empathy through custom software and analytics to provide personalized care for seniors.

What you will do

• Review Utilization Management authorization requests for medical necessity.
• Evaluate authorizations for outpatient referrals, inpatient direct admissions, post-acute referrals, and pharmacy.
• Perform peer-to-peer discussions and build collaborative relationships with community and hospital providers.
• Provide mentoring and coaching to UM nurses to strengthen effectiveness.
• Support the ongoing development of clinical guidelines and medical policies.
• Support quality improvement initiatives for members.

Requirements

• MD or DO degree.
• Board Certification in Internal Medicine, Family Medicine, Emergency Medicine, or a related specialty.
• Valid, unrestricted license to practice medicine in a U.S. state.
• Minimum of five years of clinical experience.
• At least one year of experience as a Utilization Management reviewer.
• Medicare Advantage experience.

Culture & Benefits

• Competitive base salary, equity opportunities, and a performance-based bonus program.
• Comprehensive medical, dental, and vision coverage with 401k matching.
• Remote-first culture featuring No-Meeting Fridays and monthly company holidays.
• Generous flexible time-off policy and access to mental health resources.
• Professional development funding, learning programs, and mentorship.
• Additional perks: ESPP, reimbursement for office setup, and monthly cell phone & internet stipend.