Medical Director

Jefferson Health; Philadelphia (Philadelphia County); Remote; USD 150,000 - 250,000; Part time

Job summary

An established industry player in healthcare is seeking a Medical Director to lead utilization management and care services. This role involves applying clinical expertise to ensure the delivery of necessary healthcare services, supporting accreditation processes, and developing practice guidelines. The position offers the flexibility to work remotely, making it ideal for professionals looking to balance work and personal life. Join a dynamic team where your leadership and analytical skills can make a significant impact on patient care across diverse populations. This is a unique opportunity to contribute to a forward-thinking organization dedicated to quality healthcare.

Qualifications

• 5+ years post-residency clinical practice experience required.
• Managed care experience with utilization management responsibility.

Responsibilities

• Perform utilization review for various service requests.
• Advise senior management on healthcare service utilization.

Skills

Organizational Skills

Interpersonal Skills

Communication Skills

Leadership Skills

Conflict Resolution Skills

Decision-Making Skills

Project Management Skills

Negotiation Skills

Analytical Skills

Knowledge of Utilization Management

Education

MD or DO

Pennsylvania Medical License

Board Certification in Primary Care or Relevant Specialty

Graduate Business Degree (MBA, MMM)

Tools

Excel

Access

Word

Job description

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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, hospital/health system, provider communities, and regulatory/governmental activities. Apply clinical expertise to promote the proper delivery of medically necessary services. Perform utilization, pharmacy, and quality reviews.

Essential Functions

• Perform utilization review for various service requests, including inpatient, outpatient, pharmacy, and dental, with peer-to-peer discussions with providers.
• Support and serve on committees such as Utilization Management and Pharmacy & Therapeutics.
• Advise senior management on utilization of healthcare services to ensure effective delivery of necessary services.
• Participate and/or lead rounds related to disease management, care management, or admissions.
• Support accreditation processes (NCQA) and programs in Utilization, Quality, and Disease Management.
• Contribute to ongoing care activities across OB, pediatric, adolescent, adult, and geriatric populations.
• Develop or revise practice guidelines for acute and chronic care.
• Create and implement policies to promote effective utilization management and meet targets.
• Collaborate with Economics and Finance to improve data on resource utilization and outcomes.
• Represent HealthCare Management internally and externally as directed.
• Develop work plans to optimize utilization and quality targets.
• Perform other duties as assigned.

Work from Home

This position is available to work remotely.

Required Education and Experience

• MD or DO required.
• Pennsylvania Medical License without restrictions.
• Board certification in a primary care or relevant specialty.
• Graduate business degree (MBA, MMM, etc.) is a plus.
• At least 5 years post-residency clinical practice experience.
• Managed care experience with utilization management responsibility.

Skills and Abilities

• Excellent organizational, interpersonal, and communication skills.
• Strong leadership and conflict resolution skills.
• Independent decision-making and project management skills.
• Negotiation and analytical skills.
• Proficiency in PC applications such as Excel, Access, and Word.
• Knowledge of Utilization, Quality, and Care Management principles.

Additional Details

Location: 901 Market Street, Philadelphia, PA

Seniority level: Director

Employment type: Part-time

Industry: Hospitals and Health Care