Remote Medical Director

Overview

This role involves directing and coordinating medical management, quality improvement, and credentialing functions while providing medical leadership to improve quality and cost-effectiveness of care for members.

In Short

• Assist Chief Medical Director in medical management oversight.
• Perform medical review activities for utilization and quality assurance.
• Support performance improvement initiatives for providers.
• Conduct rounds to assess care for high-risk patients.
• Collaborate with clinical teams and network providers.
• Participate in provider network development and market expansion.
• Identify and evaluate trends in utilization of medical services.
• Review complex claims for medical necessity.
• Develop alliances with the provider community.
• Represent the business unit at state committees.

Requirements

• Medical Doctor or Doctor of Osteopathy.
• Utilization Management experience preferred.
• Current Pennsylvania state license as MD or DO.
• Board certification in a recognized medical specialty.
• Experience with culturally diverse populations preferred.
• Coursework in Health Administration or related fields is advantageous.

Benefits

• Competitive pay and health insurance.
• 401K and stock purchase plans.
• Tuition reimbursement and paid time off.
• Flexible work schedules including remote options.
• Commitment to diversity and equal opportunity.