Medical Director, Utilization Management - Remote (Contract to Hire)

Citius Healthcare Consulting is partnering with a leading health plan client based in Pittsburgh, PA to bring on additional experienced Medical Directors supporting utilization management.
This is a fully remote, contract role with a real path to full-time conversion for the right physicians.
What you'll do As part of a physician team, you'll review escalated cases against medical policy criteria to determine medical necessity and appropriateness — including telephonic peer-to-peer discussions. You'll handle initial determinations, appeals, and grievances, and write clear, compliant rationales for members and providers. You'll also serve as the physician voice on a multidisciplinary care and disease management team, advising on high-risk cases, joining huddles and grand rounds, and contributing to protocol and guideline development.
What we're looking for
MD or DO with active state licensure in PA, NY, or WV
Board certification (ABMS or AOA) at least once in your specialty
5+ years of clinical, direct patient care experience
Payer-side UM experience required — utilization management from the health-plan side, not just the hospital side, is what sets top candidates apart
Strong clinical judgment, clear written and verbal communication, and comfort working across clinical systems
Experience with MCG or InterQual
Prior medical management experience within a health insurance plan
U.S. citizenship required
Nice to have
MBA, MHA, or MPH
The details
Fully remote, must work 40 hrs/week
Core hours 9am–5pm EST, flexible across time zones once trained, potential for change in hours once established
Open to both Behavioral Health and Physical Health backgrounds
Contract with strong potential to convert to a permanent role
Rate will be based on experience but expect contractor rate of $180 - $220 an hour
If you're a board-certified physician who knows utilization management from the payer side — or you know someone who does — our team would love to connect. Please apply if your qualified. Send me a DM if you have a referral or encourage your colleague to apply.
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Work arrangement
No