Medical Director II, Utilization Management

Location: Remote USA

Salary: $280,000–$345,000 per year

Company

hirify.global operates an integrated care platform focused on improving the health and well-being of older Americans through clinical, service, data, and AI capabilities.

What you will do

• Help develop and maintain an efficient utilization management program aligned with member needs, quality standards, evidence-based guidelines, and company values.
• Perform clinical reviews, including Part A, Part B, appeals, and quality-of-care reviews, and conduct peer-to-peer discussions with physicians.
• Analyze utilization data and identify opportunities to improve care quality, efficiency, and resource allocation.
• Provide clinical leadership, mentoring, and subject-matter expertise to clinical and non-clinical staff.
• Support utilization management, quality management, clinical services, and care management programs, including acute and post-acute clinical rounds.
• Participate in committees, workgroups, inter-rater reliability activities, and discussions with network physicians about medical policies, utilization, resources, and quality.

Requirements

• Medical Doctor (M.D.) or Doctor of Osteopathy (D.O.) degree from an accredited medical school.
• At least five years of clinical practice experience.
• At least three years of medical director experience in utilization management or medical management within a health plan, medical group, or hospital.
• Must be based in the United States for this remote role.

Nice to have

• Experience developing and implementing new processes.
• Commitment to population health, high-value care, quality, safety, and effective resource allocation.
• Strong problem-solving skills, comfort with ambiguity, and the ability to guide others through complex situations.

Culture & Benefits

• Employer-sponsored health, dental, and vision plans with low or no premiums.
• Generous paid time off and parental leave.
• $100 monthly mobile or internet stipend.
• Stock options for all employees.
• 401(k) program and bonus eligibility policies for eligible roles.
• Collaborative, diverse, and supportive work environment.