Associate Medical Director, Utilization Management

Location: Remote within the United States; candidates must hold an active medical license in Florida, Arizona, or North Carolina, or an IMLC compact license. Occasional travel may be required for team meetings and company events.

Salary: $240,120–$315,157 annually, plus performance bonus and employee benefits.

Company

hirify.global is a health insurance company built around a full-stack technology platform and focused on member care.

What you will do

• Review inpatient, outpatient, and pharmacy services and make timely medical-necessity determinations using evidence-based criteria and internal guidelines.
• Document clinical decisions and communications accurately in workflow tools using the appropriate templates.
• Handle escalated reviews and conduct peer-to-peer discussions with treating providers.
• Lead and oversee a team of physicians, including performance management and quality oversight.
• Ensure the team meets turnaround-time requirements for clinical reviews.
• Collaborate across Utilization Management Operations and lead key projects through completion.

Requirements

• Board certification as an MD or DO with a current unrestricted license to practice medicine.
• At least 3 years of clinical practice experience.
• At least 2 years of utilization review experience in a managed care plan or the healthcare industry.
• Active medical licensure in Florida, Arizona, or North Carolina, or an IMLC compact license.

Nice to have

• Licensure in multiple Oscar states.
• Experience with care management in the health insurance industry.
• Willingness and ability to obtain additional state licenses as business needs require, with support from Oscar.

Culture & Benefits

• Remote work from a home office with occasional travel for team meetings and company events.
• Performance bonus and unlimited paid time off.
• Medical, dental, and vision benefits.
• Paid holidays, sick time, parental leave, wellness time, and reimbursements.
• 401(k) participation, life insurance, and disability insurance.
• Equal-opportunity environment focused on belonging and support.