Pennsylvania Licensed Medical Director

Job Summary

To support the Utilization Management team, the full-time Pennsylvania Licensed Medical Director will oversee adherence to quality and utilization standards, ensure comprehensive healthcare delivery to members, and lead provider credentialing processes in a fully remote capacity.

Key responsibilities

• Provide leadership direction for provider credentialing processes and ensure timely medical decisions
• Participate in utilization management and quality improvement reviews, addressing member grievances and provider appeals
• Communicate clinical guidelines and standards to network providers while supporting Quality Improvement and Care Management goals

Required qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (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