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 preferred.
- Strong knowledge of prior authorization processes and medical necessity criteria.
- Excellent communication, organizational, and decision-making skills.
- Proficiency with Microsoft Office and remote work technology.
Compensation & Benefits - Salary: $250,000"$350,000 annually DOE.
- Comprehensive benefits package including medical, dental, vision, 401(k), paid time off, life insurance, FSA, tuition reimbursement, CME/license reimbursement, and employee assistance programs.
This is an excellent opportunity to join one of Southern California's fastest-growing physician organizations in a leadership role that supports quality patient care while maintaining work-life balance.
