Assistant Medical Director – Utilization Review

Job overview

The Assistant Medical Director – Utilization Review role is a work-from-home opportunity, with the posting specifying five days per week and one to two Saturdays per month, operating on Pacific Standard Time. The national salary range is $214,500–$386,100 per year. The role supports Premera’s medical review and clinical programs. The physician makes health-plan coverage determinations using medical necessity, clinical documentation, medical policy criteria, and member contracts. The role also supports clinical programs, peer-to-peer discussions, review-criteria governance, and education to promote consistent, compliant decisions for members.

What you'll do

• Conduct pre-service, post-service, concurrent facility-based, and transition-of-care reviews
• make coverage decisions based on medical necessity and applicable contract terms
• support claims review decisions
• communicate with external physicians and providers in peer-to-peer discussions
• consult with clinical staff on member care options
• participate in development and approval of medical review criteria
• support clinician education
• provide professional consultation
• participate in inter-rater review
• comply with regulatory and accreditation requirements.

What we're looking for

Skills & competencies

assistant medical director

utilization review

remote work

medical necessity

coverage determinations

clinical review

peer-to-peer review

medical policy committee

washington licensure

premera blue cross

$214,500–$386,100 per year

Work arrangement

• Weekend coverage required

Benefits & perks

• Medical, vision and dental coverage
• voluntary benefits
• life and disability insurance
• 401(k) match and pension
• wellness resources
• paid time off
• tuition assistance
• employee recognition program.

Why this role

Requires an MD or DO, an unrestricted Washington state license or administrative license or ability to obtain one within 90 days, and five years of clinical experience; board certification is preferred.

About the employer

Premera Blue Cross is hiring for this role. Industry: Offices of Physical, Occupational and Speech Therapists, and Audiologists. Sector: 62.