Pennsylvania Licensed Medical Director

Job Summary

Responsible for assuring physician commitment and delivering comprehensive high-quality health care to members, the full-time Pennsylvania Licensed Medical Director will lead utilization management processes and quality improvement initiatives in a fully remote capacity.

Key responsibilities

• Provide leadership direction for provider credentialing processes and ensure adherence to quality and utilization standards
• Participate in daily utilization management and quality improvement reviews, including concurrent, prospective, and retrospective assessments
• Communicate clinical guidelines and standards to network providers while representing the Health Plan in external accreditation activities

Required qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathy (DO) from an accredited school
• Minimum of 5-10 years of clinical experience
• Managed care experience preferred
• Board certification in Internal Medicine, Family Medicine, Geriatric Medicine, or Emergency Medicine is preferred
• Valid Pennsylvania Medical License