Pennsylvania Licensed Medical Director

Job Summary

To ensure high-quality healthcare delivery, the full-time Pennsylvania Licensed Medical Director will oversee utilization management processes, provide leadership in quality improvement initiatives, and maintain effective relationships with healthcare providers in a fully remote setting.

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 the Health Plan's Quality Improvement and Care Management Programs

Required qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathy (DO) from an accredited school
• A minimum of 5-10 years of clinical experience
• Managed Care experience preferred
• Experience with Payor Utilization Management highly preferred
• Board certification in Internal Medicine, Family Medicine, Geriatric Medicine, or Emergency Medicine is preferred