Medical Director

TL;DR

Medical Director: Providing physician leadership for medical management and utilization review programs with an accent on evidence-based clinical guidelines, utilization review decision-making, and compliance with regulatory requirements. Focus on complex medical necessity determinations, quality/performance monitoring, and cross-functional policy development to ensure defensible, high-quality outcomes.

Location: Remote (US based)

Company

hirify.global provides integrated healthcare solutions for employers, payers, providers, and members to reduce costs and improve quality.

What you will do

• Lead development, implementation, and evaluation of evidence-based clinical guidelines, medical policies, and utilization management protocols.
• Ensure clinical programs and utilization review processes align with standards of care, evidence-based medicine, accreditation requirements, and applicable federal/state regulations.
• Serve as clinical authority for complex, high-risk, or escalated utilization review cases, including final medical necessity determinations.
• Collaborate with Clinical Operations, Compliance, Legal, and executive leadership to develop, review, and revise clinical and administrative policies.
• Oversee quality and performance initiatives by reviewing outcomes, analyzing quality metrics, and participating in quarterly Quality Committee meetings.
• Support audits, accreditation/regulatory reviews, and quality improvement initiatives; provide physician consultation for post-service medical necessity, appeals, and complex cases.

Requirements

• MD or DO with an active, unrestricted medical license.
• Board certification in a recognized specialty.
• Experience with utilization management, medical policy development, and clinical program oversight.
• Familiarity with applicable regulations (e.g., CMS, URAC, and state-specific requirements).
• Active, unrestricted Texas medical license (full licensure, not an administrative license).
• US-based and able to hold active medical licenses in states that require physician licensure for utilization reviews (current priorities: Maryland, New Hampshire, West Virginia, Texas).

Culture & Benefits

• Fully remote role with company-provided equipment.
• Subsidized Medical, Dental, and Vision insurance; access to services through company products.
• Spending accounts: HSA, FSA, and DCFSA; 401K with company match and immediate vesting.
• Flexible working environment and generous paid time off (vacation, sick leave, paid holidays).
• Employee Assistance Program with professional counseling and referrals; paid maternity and paternity leave.
• 401K, HSA/FSA/DCFSA, and other employee perks including pet insurance and community giveback opportunities.

Hiring process

• Interviews to assess clinical leadership, utilization management experience, and policy/compliance knowledge.
• Evaluation of licensure eligibility and ability to support utilization review requirements across prioritized states.