Medical Director

Jefferson Health; Philadelphia (Philadelphia County); Remote; USD 160,000 - 200,000; Part time

Job summary

Jefferson Health is seeking a Medical Director to oversee Utilization Management and Care Management. The role requires a Medical Physician (MD or DO) with a Pennsylvania medical license and at least 5 years post-residency clinical practice. Responsibilities include conducting utilization reviews, advising senior management on service delivery, and supporting operational improvements. This position offers a chance to lead clinical governance in a nationally ranked health system with opportunities for remote work.

Qualifications

• Medical degree required with board certification.
• Minimum 5 years post-residency clinical practice experience.
• Experience in managed care and utilization management.

Responsibilities

• Perform utilization review for hospital and outpatient services.
• Advise senior management on effective healthcare service delivery.
• Support utilization management committees and quality reviews.

Skills

Organizational skills

Interpersonal skills

Time management skills

Leadership

Conflict resolution

Decision-making

Analytical skills

Education

Medical Physician (MD or DO)

Pennsylvania Medical License

Board Certification in a specialty

Graduate business degree (MBA, MMM)

Job description

Join to apply for the Medical Director role at Jefferson Health

3 days ago Be among the first 25 applicants

Join to apply for the Medical Director role at Jefferson Health

Get AI-powered advice on this job and more exclusive features.

Job Details

Function as an integral part of the HealthCare Management team responsible for Utilization Management, Care Management, and Pharmacy Services programs. Represent HealthCare Management in interdepartmental activities and represent Health Partners in the hospital/health system and provider communities and regulatory and governmental activities. Apply clinical expertise and experience as a provider to promote the proper delivery of medically necessary services to the population served. Perform utilization, pharmacy, and quality reviews.

Job Details

Function as an integral part of the HealthCare Management team responsible for Utilization Management, Care Management, and Pharmacy Services programs. Represent HealthCare Management in interdepartmental activities and represent Health Partners in the hospital/health system and provider communities and regulatory and governmental activities. Apply clinical expertise and experience as a provider to promote the proper delivery of medically necessary services to the population served. Perform utilization, pharmacy, and quality reviews.

Job Description

Essential Functions:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Perform utilization review for requests for services including but not limited to inpatient, outpatient, pharmacy and dental. This will include peer-to-peer discussions with providers.
• Serve on and support the functions of committees including but not limited to the Utilization Management Committee and Pharmacy & Therapeutics Committee.
• Advise the HealthCare Senior Management team regarding the utilization of health care services and interventions to promote the effective delivery of medically necessary services.
• Participate and/or lead rounds including but not limited to disease management, care management or admissions.
• Provide support for Plan accreditation processes (NCQA), Utilization, Quality and Disease Management programs.
• Support ongoing activities in OB, pediatric, adolescent, adult preventative, and geriatric care.
• Develop and or revise practice guidelines for acute and chronic care.
• Develop and implement policies and procedures required to promote effective utilization management and achieve established targets.
• Collaborate with HealthCare Economics and Finance to continuously improve the collection and use of data describing resource utilization and outcomes.
• Represent HealthCare Management internally and externally at the direction of the VP Chief Medical Officer.
• Develop and implement work plans to optimize appropriate utilization and quality targets as directed by the VP Chief Medical Officer.
• Perform other job duties as assigned.
  
  

Work from Home

This position is available to work from home

Required Education And Experience

• Medical Physician (MD or DO) required.
• Pennsylvania Medical License without restriction.
• Board Certification in a specialty (primary care preferred)
• Graduate business degree is a plus (MBA, MMM, etc.).
• Minimum 5 years post-residency experience in the clinical practice of medicine.
• Managed care experience, with responsibility for utilization management.
  
  

Skills/Abilities

• Excellent organizational, interpersonal, time management and communications skills.
• Strong leadership skills.
• Strong conflict resolution and independent decision-making skills.
• Expert project management ability.
• Strong influencing, negotiation and analytical skills.
• Working knowledge of PC based applications such as Excel, Access and Word.
• Knowledge of the principles of Utilization, Quality and Care Management.
  
  

Work Shift

Workday Day (United States of America)

Worker Sub Type

Temporary

Primary Location Address

901 Market Street, Philadelphia, Pennsylvania, United States of America

Nationally ranked, Jefferson, which is principally located in the greater Philadelphia region, Lehigh Valley and Northeastern Pennsylvania and southern New Jersey, is reimagining health care and higher education to create unparalleled value. Jefferson is more than 65,000 people strong, dedicated to providing the highest-quality, compassionate clinical care for patients; making our communities healthier and stronger; preparing tomorrow's professional leaders for 21st-century careers; and creating new knowledge through basic/programmatic, clinical and applied research. Thomas Jefferson University, home of Sidney Kimmel Medical College, Jefferson College of Nursing, and the Kanbar College of Design, Engineering and Commerce, dates back to 1824 and today comprises 10 colleges and three schools offering 200+ undergraduate and graduate programs to more than 8,300 students. Jefferson Health, nationally ranked as one of the top 15 not-for-profit health care systems in the country and the largest provider in the Philadelphia and Lehigh Valley areas, serves patients through millions of encounters each year at 32 hospitals campuses and more than 700 outpatient and urgent care locations throughout the region. Jefferson Health Plans is a not-for-profit managed health care organization providing a broad range of health coverage options in Pennsylvania and New Jersey for more than 35 years.

Jefferson is committed to providing equal educational and employment opportunities for all persons without regard to age, race, color, religion, creed, sexual orientation, gender, gender identity, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, handicap or disability or any other protected group or status.

Seniority level

• Seniority level

  Director

Employment type

• Employment type

  Part-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

Referrals increase your chances of interviewing at Jefferson Health by 2x

Get notified about new Medical Director jobs in Philadelphia, PA.

VP, Engagement Director (Client Services)

Senior Vice President, Chief Medical Officer (CMO)

Philadelphia, PA $160,000.00-$180,000.00 2 weeks ago

Medical Operations Manager/ Practice Manager

Executive Director, Medical Capabilities

Medical Director/Senior Director, Clinical Development

Berwyn, PA $130,000.00-$140,000.00 3 weeks ago

Administrative Director - Radnor Surgery Center at Penn Medicine

Newtown Square, PA $53,315.00-$108,487.00 2 weeks ago

Director of Nursing and Advanced Practice Administration

Medical Operations Manager/ Practice Manager

Medical Director - Outpatient Pediatrics

Medical Operations Manager/ Practice Manager

National Director, Field Medical Affairs

Plymouth Meeting, PA $219,000.00-$252,400.00 1 week ago

Senior Director, GCP/GVP/GLP Quality Assurance

King of Prussia, PA $209,000.00-$296,500.00 3 days ago

Director, Management Advisor, Medical Affairs

East Norriton, PA $160,000.00-$190,000.00 1 week ago

Philadelphia, PA $174,070.00-$374,920.00 2 weeks ago

Philadelphia, PA $174,070.00-$374,920.00 1 week ago

Medical Director/Senior Medical Director, Clinical Development

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.