Medical Director in Pittsburgh, Pennsylvania at Advance Sourcing Concepts LLC

Position Overview

We are seeking an experienced, licensed Medical Director – Utilization Management to review medical cases and determine the medical necessity and appropriateness of healthcare services. The ideal candidate will have strong clinical experience and knowledge of utilization management, preferably within a health insurance or managed care organization.

Key Responsibilities
Review medical cases to determine medical necessity and appropriateness of treatment.
Conduct peer-to-peer discussions with healthcare providers as needed.
Review appeals, grievances, and medical determinations.
Collaborate with clinical teams on complex medical cases.
Ensure compliance with healthcare regulations and clinical guidelines.
Maintain accurate documentation and meet daily case review expectations.

Required Qualifications
Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO).
Must have an active, unrestricted medical license in Pennsylvania, New York, or West Virginia.
Minimum of 5 years of direct patient care experience.
Must have obtained board certification at least once in a recognized medical specialty.
Knowledge of utilization management and managed care practices.
Strong clinical judgment, communication, and computer skills.
Must be a U.S. citizen.

Preferred Qualifications
Utilization management experience within a health insurance company or managed care organization.
At least 1 year of medical management experience within a health insurance plan.
Experience with MCG or InterQual guidelines.
Master's degree in Business Administration, Management, or Public Health.

Additional Information
100% remote position.
Contract opportunity with potential for permanent employment.
Core working hours are 9:00 AM–5:00 PM EST, with some scheduling flexibility after training.
Must complete a Medical Director assessment as part of the selection process.