VP, Physician Review and Market Insights (Utilization Management)

Location: Remote nationwide in the United States; occasional travel to hirify.global offices for training or meetings may be required.

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services to Medicare, Medicaid, families, individuals, military personnel, and communities.

What you will do

• Set clinical strategy and lead the Utilization Management organization.
• Oversee physicians, registered nurses, and non-clinical support across Medicaid and Medicare utilization management.
• Lead risk management, grievances and appeals, clinical contracting, vendor management, and dental review.
• Use analytics to guide strategy, performance improvement, trend savings, and operational efficiency.
• Integrate evidence-based approaches and ensure consistent clinical practices for UM reviewers.
• Develop clinical talent and the leadership pipeline while driving cross-functional results.

Requirements

• MD or DO degree.
• Current board certification.
• At least 10 years of combined leadership and/or Utilization Management experience.
• Deep knowledge of medical, clinical, and behavioral science supporting Utilization Management.
• Strong interpersonal, leadership, and business acumen.
• Dedicated work space protecting member PHI and HIPAA information; home internet of at least 25 Mbps download and 10 Mbps upload.

Culture & Benefits

• Fully remote work arrangement with 40 scheduled hours per week.
• Occasional travel to hirify.global offices for training or meetings.
• Work environment focused on whole-person health, quality outcomes, and evidence-based clinical practice.
• Support for improving Star Ratings, health outcomes, and operational consistency.