Medical Director, Utilization Management - Remote

Overview

The UPMC Health Plan is seeking a licensed MD or DO for a fully remote Medical Director, Utilization Management role. The Medical Director is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC Health Plan members.

In Short

• Actively participates in daily utilization management and quality improvement review processes.
• Provides expedited review and determination of medically pressing issues.
• Keeps current with accepted standards in quality improvement and utilization management.
• Communicates and educates network providers regarding clinical guidelines.
• Interacts with physicians to improve member satisfaction.
• Contributes to process improvement within the department.
• Participates in activities to support policy decision making.
• Utilizes clinical experience to support departmental reviews.

Requirements

• Doctor of Medicine or Doctor of Osteopathy from an accredited school.
• PA Medical license Required.
• 5-10 years of clinical experience preferred.
• Managed care experience is a plus.
• Internal Medicine, Family Medicine, or Emergency Medicine highly preferred.
• Licensure, Certifications, and Clearances as MD or DO.

Benefits

• Premier benefits package for total well-being.
• Opportunities for career advancement and growth.
• Supportive work environment focused on quality care.