Job Description
We are seeking a Remote Medical Director for a non-clinical role focused on prior authorization and medical necessity reviews. No direct patient care is required. Candidates must reside in the San Diego area and be available for occasional on-site meetings and trainings. Responsibilities Review prior authorization requests and determine medical necessity using evidence-based clinical guidelines. Approve, deny, modify, or redirect services as appropriate. Collaborate with nurses, physicians, and care management teams to support high-quality, cost-effective care. Participate in appeals, grievance reviews, retrospective claims reviews, and quality improvement initiatives. Serve as a clinical resource to providers on utilization management and patient care issues. Qualifications MD or DO degree required. Board Certification in Internal Medicine strongly preferred. Minimum 5 years of clinical experience required. 2+ years of managed care, health plan, or utilization management experience pr...