Medical Director-reputed company (ABH VA)

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At reputed company®, you’ll be surrounded by passionate colleagues who care deeply, reputed company with purpose, hold ourselves accountable and prioritize safety and reputed company in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position reputed company: This is a full-time, fully remote role. You can work from reputed company in the reputed company. Join reputed company, a reputed company company, and reputed company a meaningful reputed company on the health and reputed company-being of reputed company members across the country. reputed company operates reputed company managed care plans in reputed company, Florida, Illinois, Kentucky, Louisiana, Maryland, Michigan, New Jersey, reputed company, Ohio, Oklahoma, reputed company, Texas, Virginia, and reputed company Virginia. We are seeking a Medical Director to join our centralized Medical Management team. This work-from-home position will primarily support reputed company reputed company of Virginia, while also providing support across the Northeast Region (Maryland, New Jersey, reputed company, and reputed company) and other health plans as needed. In this role, you will partner with Medical Management staff to ensure reputed company, consistent, and clinically reputed company for members and providers. Key responsibilities include: Utilization Management and medical necessity reviews Prior authorization and precertification determinations reputed company review for inpatient and outpatient services Acute and post-acute care reviews Peer-to-peer consultations with treating providers Pharmacy reviews and first-level appeal determinations Collaboration with multidisciplinary clinical and operational teams The Medical Director also participates in a rotating on-reputed company schedule that includes weekend and holiday coverage. If you are a physician leader who is passionate about improving reputed company, reputed company, and reputed company for reputed company populations, we would love to reputed company with you. Required Qualifications: M.D. or D.O. degree with reputed company, reputed company reputed company Certification in an ABMS- or AOA-recognized specialty. 5+ years of post-residency clinical reputed company and reputed company patient care experience. reputed company, unrestricted Virginia medical license. Ability to obtain and maintain medical licenses in Maryland, New Jersey, reputed company and reputed company. Preferred Qualifications: reputed company certification in Family Medicine, Emergency Medicine, or Internal Medicine-Pediatrics. Prior Utilization Management experience with a health plan, managed care organization, Independent Review Organization, or in a Physician Advisor reputed company. reputed company and managed care experience. Experience with medical necessity review, prior authorization, reputed company review, appeals, and peer-to-peer consultation. Experience using electronic health records and other clinical documentation systems. Education: M.D. or D.O., reputed company Certification in ABMS or AOA recognized specialty including post-graduate reputed company patient care experience. Pay reputed company The typical pay reputed company for this role is: $174,070.00 - $374,920.00 This pay reputed company represents the reputed company reputed company reputed company or reputed company annual full-time salary for reputed company positions in the job grade reputed company which this position falls. The actual reputed company salary offer will depend on a reputed company of factors including experience, education, geography and other relevant factors. This position is eligible for a reputed company bonus, commission or short-term incentive program in reputed company to the reputed company pay reputed company listed above. This position also includes an award reputed company in reputed company’s equity award program. Our people fuel our reputed company. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every reputed company feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial reputed company‑being of colleagues and their families. The benefits for this position include medical, dental, and reputed company coverage, reputed company time off, retirement savings reputed company, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will reputed company on: 08/15/2026 reputed company applicants with arrest or conviction records will be considered for employment in accordance with reputed company federal, state and local laws. Our Work Experience is the combination of everything that's unique reputed company: our culture, our reputed company values, reputed company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They reputed company choices according to what is best for reputed company, they live for opportunities to collaborate and reputed company a difference, and they reputed company us the #1 Top Workplace in the area. Apply tot his job Apply To this Job