Medical Director - Inpatient Review (Utilization Management)

Location: Remote nationwide within the United States; occasional travel to hirify.global offices for training or meetings may be required. Standard hours are Monday through Friday, 8:00 a.m. to 5:00 p.m. local time, with rotational weekend and holiday coverage.

Salary: $223,800–$313,100 per year, plus eligibility for a bonus incentive plan.

Company

hirify.global is a U.S. healthcare company providing insurance and healthcare services to Medicare, Medicaid, individual, family, military, and community populations.

What you will do

• Review inpatient medical records and assess medical necessity using national guidelines, CMS regulations, hirify.global policies, and recognized clinical standards.
• Analyze complex hospital cases and issue clear, well-reasoned utilization management determinations.
• Communicate with external providers by phone to obtain clinical information and discuss review outcomes.
• Complete reviews accurately and promptly in accordance with regulatory requirements.
• Document verbal and written determinations and adapt to changing workflows, tools, and procedures.
• Participate in committees or special project teams as needed.

Requirements

• MD or DO degree.
• At least 5 years of clinical experience after residency.
• Active, unrestricted medical license in at least one U.S. state and willingness to obtain additional licenses as needed.
• Current board certification in an AOABPS- or ABMS-recognized medical specialty and completion of all credentialing requirements without state or federal sanctions.
• Strong analytical, communication, and documentation skills.
• Ability to work effectively in a structured, multidisciplinary environment.

Nice to have

• Inpatient experience at hospitalist-level acuity, in emergency medicine, critical care, or hospital-based family or internal medicine.
• Utilization management or inpatient review experience across Medicare Advantage, Managed Medicaid, or commercial lines.
• Familiarity with MCG or InterQual guidelines and experience with Medicare populations.
• Experience in hospitals, integrated delivery networks, or medical management organizations.
• Interest in education, team teaching, professional development, clinical technology, and process improvement.

Culture & Benefits

• Structured, team-oriented environment emphasizing integrity, professionalism, and collegiality.
• Dedicated workspace without ongoing interruptions is required to protect member PHI and HIPAA information.
• Home internet must provide at least 25 Mbps download and 10 Mbps upload speeds.
• hirify.global provides appropriate telephone equipment; internet expense payments are available for eligible home-based employees in California, Illinois, Montana, and South Dakota.
• Benefits include medical, dental and vision coverage, 401(k), paid time off, holidays, parental and caregiver leave, disability coverage, and life insurance.