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Physician / Internal Medicine / California / Permanent / Remote Medical Director " Prior Authorization Experience Needed - Pomona, California Job
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 LAarea 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.
