Physician Medical Director

About the role

We are looking for a Physician Medical Director to join our physician‑led team and provide high‑level clinical advocacy for hospitals across the United States. The role combines clinical expertise with strategic negotiation to overturn inappropriate payer denials and improve admission approval rates.

Key responsibilities

• Conduct forensic clinical reviews of patient records and status determinations.
• Lead Peer‑to‑Peer (P2P) consultations with payer medical directors.
• Advocate for hospitals by challenging inappropriate denials using evidence‑based criteria.
• Draft comprehensive Clinical Advocacy Notes for legal and compliance records.
• Collaborate with utilization management teams to optimize clinical workflows.

Required profile

• Board certification in a medical specialty (e.g., Medicine, Surgery, Cardiology, Pediatrics).
• Minimum five years of clinical practice experience.
• Strong working knowledge of Milliman, InterQual, and national coverage criteria.
• Excellent communication and negotiation abilities.
• Licensed to practice medicine in at least one U.S. state.
• Experience with utilization management or payer relations is preferred.

Required skills

• Milliman
• InterQual
• National coverage criteria