Hybrid Utilization Management Physician Operations Lead

UPMC; Pittsburgh (Allegheny County); Hybrid; USD 120,000 - 190,000; Full time

Job summary

UPMC is seeking an Utilization Management Physician Operations Manager to drive operational effectiveness and coordination of Medical Director activities within the health plan. You will partner with medical directors, clinical leaders, and cross-functional teams to ensure timely case progression and high service standards in a hybrid role on-site in Downtown Pittsburgh three days a week.

This role requires strong leadership, data-driven decision making, and the ability to streamline scheduling,

Responsibilities

• Own end-to-end Medical Director scheduling, including PTO, coverage, and workload balancing.
• Maintain centralized, real-time calendars (reviews, appeals, hearings, committees).
• Proactively identify and resolve coverage gaps using workload and volume data.
• Ensure equitable distribution of work during PTO, holidays, and unplanned absences.
• Serve as primary point of contact for scheduling, availability, and coverage coordination.
• Support short- and long-term capacity planning aligned to volumes and regulatory timelines.
• Provide reporting and insights on scheduling trends to inform staffing decisions.
• Provide day-to-day operational support for Medical Directors across core activities.
• Coordinate scheduling and prioritization of reviews, appeals, peer-to-peer calls, and hearings.
• Act as primary operational liaison for workflow, process, and scheduling inquiries.
• Lead onboarding and coordination of training for Medical Directors, including System access and tools, Regulatory and compliance training, Role-specific workflows and expectations.
• Monitor completion of required onboarding and training milestones.
• Coordinate end-to-end workflows supporting Medical Director decision-making (intake, prioritization, tracking, and cross-functional handoffs).
• Partner with UM, Quality, Appeals, Legal, Pharmacy, Operations and other functional areas within the IDFS to ensure alignment.
• Proactively identify and partner to resolve operational inefficiencies, bottlenecks, and recurring issues.
• Drive continuous process improvement initiatives with measurable outcomes
• Plan, schedule and support Medical Director meetings, committees, and case review sessions.
• Develop agendas, prepare materials, and manage logistics.
• Track decisions, risks, and action items to ensure accountability and follow-through.
• Support governance structures and documentation standards.
• Data, Reporting & Performance Insights.
• Monitor key operational metrics (volume, turnaround time, productivity, SLA performance) and lead weekly/monthly reporting to leadership.
• Develop dashboards and reports to support leadership visibility and decision-making.
• Analyze trends to inform staffing models, workload balancing, and process improvements.
• Provide actionable insights to drive operational efficiency and performance.
• Regulatory & Operational Readiness: Support audit readiness (NCQA, CMS, internal audits) and accreditation activities.
• Ensure workflows and documentation align with regulatory and compliance standards.
• Partner with compliance and quality teams to maintain operational integrity.
• Proactively address risks related to timeliness, documentation, and process adherence

Job description

UPMC is seeking an Utilization Management Physician Operations Manager to drive operational effectiveness and coordination of Medical Director activities within the health plan. You will partner with medical directors, clinical leaders, and cross-functional teams to ensure timely case progression and high service standards in a hybrid role on-site in Downtown Pittsburgh three days a week.

This role requires strong leadership, data-driven decision making, and the ability to streamline scheduling,