Pennsylvania Licensed Medical Director

Job Summary

A company is looking for a Medical Director, Appeals.

Key Responsibilities

• Ensure quality and clinically sound services for all enrollees through associates and providers
• Serve as medical advisor and manager for all clinically related activities, ensuring adherence to medical policies and procedures
• Collaborate with multidisciplinary teams to improve clinical effectiveness and manage day-to-day operations

Required Qualifications

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) required
• Master's degree in Health Administration, Public Health, or Business Administration in Healthcare Management preferred
• Minimum of three years of utilization management or appeal experience preferred
• Minimum of five years of clinical practice experience required
• Active Pennsylvania medical license required, with additional licensure in states where the company operates