Pennsylvania Licensed Medical Director

Job Summary

A company is looking for a Medical Director to oversee clinical review processes and ensure high-quality medical management.

Key Responsibilities

• Conduct electronic reviews of escalated cases against medical policy criteria
• Complete initial case determinations, review appeals, and perform other assigned reviews
• Advise the multidisciplinary team on cases requiring physician expertise and participate in protocol development

Required Qualifications

• Active, unrestricted medical state licensure in Pennsylvania, New York, or West Virginia
• Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)
• 5+ years in clinical, direct patient care settings
• 1+ year in medical management within a health insurance plan
• Board certification in a specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association