Pennsylvania Licensed Medical Director

Job Summary

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

Key Responsibilities

• Provide leadership direction for provider credentialing processes and quality improvement goals
• Participate in utilization management and quality improvement reviews, including medical decision-making and provider appeals
• Communicate clinical guidelines and standards to network providers and represent the Health Plan in accreditation activities

Required Qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathy (DO) from an accredited school
• PA Medical license required
• 5-10 years of clinical experience, preferably in managed care
• Experience in Internal Medicine, Family Medicine, or Emergency Medicine is highly preferred