Pennsylvania Licensed Medical Director

Job Summary

A company is looking for a Medical Director Utilization Management.

Key Responsibilities

• Identify and implement evidence-based practice guidelines across the provider network
• Oversee the quality of clinical care for network and non-network providers
• Ensure adherence to contractual obligations and regulatory requirements in medical management operations

Required Qualifications, Training, and Education

• MHA, MPH, or MBA in healthcare management preferred
• Minimum of three (3) years of utilization management or appeal experience in a relevant health plan
• Minimum of five (5) years of clinical practice experience required
• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine licensed to practice as a medical director
• Board-certified in Family Medicine, Internal Medicine, or Emergency Medicine