Remote Utilization Review Rn Jobs in Gilbert, AZ

Are you an accomplished physician leader seeking a prestigious, high-impact executive position with a strong work-life balance? We are actively recruiting a Medical Director specializing in Surgery, Orthopedics, or Physical Medicine & Rehabilitation (PM&R) to provide strategic clinical leadership for TriWest Healthcare Alliance. This physician executive role focuses completely on utilization management, medical necessity reviews, appeals, and clinical governance supporting military members, veterans, and their families. To ensure our leaders maintain sharp, active clinical judgment, this position features a unique dual-practice model: you will dedicate 75% of your time (3 days per week) to TriWest's remote administrative operations and 25% (1 day per week) to your own private practice or locum tenens work. Step into a highly collaborative, tech-forward infrastructure where your specialized medical insights drive macroscopic healthcare transformation.

• Coverage Determinations: Evaluate complex surgical, orthopedic, rehabilitation, and specialty care cases, making accurate coverage and medical necessity determinations based on evidence-based guidelines.

• Appeals & Peer Reviews: Direct robust clinical appeals reviews and conduct collaborative peer-to-peer discussions with network providers.

• Policy Development: Provide expert clinical guidance to support the development, enhancement, and implementation of healthcare policies and quality oversight structures.

• Operational Collaboration: Partner closely with clinical operations, provider relations, quality management, and executive leadership teams to optimize network performance.

• Performance Frameworks: Monitor key performance indicators (KPIs) and quality metrics to align workflows with regulatory compliance and accreditation standards.

• Dual-Practice Integration: Actively maintain an outside clinical footprint (1 day per week) in your specialty field to continuously inform your executive decision-making with modern practice standards.

• Other duties as assigned.

• Educational Credentials: Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree.

• Board Certification: Current Board Certification in General Surgery, Orthopedic Surgery, or Physical Medicine & Rehabilitation (PM&R).

• Licensure: An active, unrestricted state medical license.

• Executive Leadership: Previous experience as a Medical Director, Associate Medical Director, Chief Medical Officer, Department Chair, Physician Advisor, or Physician Reviewer.

• Managed Care Competency: Strong experience in Utilization Management (UM), Medical Necessity Reviews, Appeals Reviews, and health plan/managed care frameworks.

• Geographic Alignment: Must currently reside in an approved TriWest work state.

• Practice Split Commitment: Full agreement to maintain a split schedule consisting of 75% (3 days) administrative leadership with TriWest and 25% (1 day) active external clinical practice.

• Government Healthcare Expertise: Prior experience working with TRICARE, the Defense Health Agency (DHA), Department of Defense (DoD), Veterans Affairs (VA), or Military Treatment Facilities (MTFs) is highly preferred.

• Network Management: Experience supporting geographically dispersed or multi-site provider networks.

• Multidisciplinary Leadership: Proven track record of guiding multidisciplinary teams and collaborating successfully with nursing and operational executives.

• Work Type: Full-Time Contract Opportunity

• Work Setting: 100% Remote (Must reside within an approved state).

• Approved Work States: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TND, TX, UT, VA, WA, WI, WY.

• Schedule: Structured 40-hour work week

• Hourly Pay Rate: $140.00 – $145.00 per hour.

• Perks: This high-priority "hot" search moves incredibly fast, offering rapid interview turnarounds, substantial career progression pathways, and the unique flexibility to retain your active clinical practice while stepping into elite executive leadership.

If you're interested, please reply to this advertisement or directly email your resume to me at DSalgado@teemagroup.com or by calling/texting (949) 295-5951.

I strive to reply within 48 hours. Looking forward to connecting with you soon. Thank you!