Pennsylvania Licensed Medical Director

Job Summary

A company is looking for a Medical Director of Utilization Management.

Key Responsibilities

• Implement evidence-based practice guidelines and oversee clinical care quality
• Ensure compliance with medical policies, contracts, and regulatory requirements
• Collaborate with teams to enhance clinical effectiveness and manage day-to-day operations

Required Qualifications, Training, and Education

• MHA, MPH, or MBA in healthcare management preferred
• Minimum of three years of utilization management or appeal experience preferred
• Minimum of five years of clinical practice experience required
• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine with necessary state licensure
• Board-certified in Family Medicine, Internal Medicine, Pediatrics, or Emergency Medicine