Medical Director

Location: Working from home in Pennsylvania, United States.

Company

hirify.global is a healthcare organization providing health insurance and integrated care management services.

What you will do

• Review escalated cases, appeals, grievances, and treatment requests against medical policy criteria.
• Determine medical necessity and appropriateness of services and prepare clear rationales for member and provider notifications.
• Conduct telephonic peer-to-peer discussions when required.
• Advise multidisciplinary case and disease management teams on complex and high-risk cases.
• Participate in protocol and guideline development to improve consistency in clinical review.
• Lead or contribute as a physician subject matter expert to assigned projects.

Requirements

• MD or DO degree.
• At least five years of clinical, direct patient care experience in a hospital, outpatient, or private practice setting.
• At least one year of medical management experience within 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 is required; additional state licenses may be required based on business needs.
• Critical thinking, case management, communication, collaboration, clinical software, and managed care skills.

Culture & Benefits

• Home-based work arrangement in Pennsylvania.
• Work within a physician-led, multidisciplinary care management structure.
• Regular collaboration through team huddles and grand rounds.
• Responsibilities are governed by HIPAA, privacy, information security, and applicable healthcare compliance standards.
• Travel requirement is 0%–25%.