Pennsylvania Licensed Medical Director

Job Summary

To lead clinical strategy and utilization management for integrated health plans and care management programs, a Pennsylvania Licensed Medical Director will work full-time in a remote capacity, performing utilization reviews, advising senior management, and supporting accreditation processes.

Key responsibilities

• Perform utilization review for various service requests, including inpatient and outpatient care
• Advise senior management on healthcare service utilization and participate in clinical rounds
• Develop and implement policies and guidelines to enhance utilization management and quality targets

Required qualifications

• Medical Physician (MD or DO) with an unrestricted Pennsylvania Medical License
• Board Certification in a specialty, preferably primary care
• Minimum of 5 years post-residency experience in clinical practice
• Experience in managed care with a focus on utilization management
• A graduate business degree (MBA, MMM, etc.) is a plus