Medical Director - Utilization Management

UPMC; Pittsburgh (Allegheny County); Remote; USD 200,000 - 250,000; Full time

Job summary

A leading healthcare organization is seeking a Medical Director for Utilization Management. This fully remote role involves overseeing quality standards, engaging with providers, and improving member satisfaction. The ideal candidate will have a strong clinical background and experience in managed care.

Qualifications

• 5-10 years of clinical experience and managed care experience required.

Responsibilities

• Participate in daily utilization management and quality improvement review processes.
• Communicate clinical guidelines and standards to network providers.
• Engage with physicians to improve member satisfaction.

Skills

Clinical Experience

Quality Improvement

Utilization Management

Communication

Education

Doctor of Medicine (MD)

Doctor of Osteopathic Medicine (DO)

Job description

Join to apply for the Medical Director - Utilization Management role at UPMC.

This fully remote role is responsible for ensuring physician commitment and the delivery of comprehensive, high-quality healthcare to UPMC Health Plan members. The Medical Director oversees adherence to quality and utilization standards through committee delegations and fosters effective relationships between UPMC Health Plan's network and its providers.

Responsibilities:

1. Participate in daily utilization management and quality improvement review processes, including reviews, grievances, appeals, and quality concerns.
2. Provide expedited reviews for urgent medical issues following established policies.
3. Stay current with standards and developments in quality improvement and utilization management.
4. Communicate clinical guidelines and standards to network providers.
5. Engage with physicians to improve member satisfaction and compliance with policies.
6. Contribute to process improvements within the department.
7. Support policy decision-making activities.
8. Use clinical experience to support departmental reviews.

This position requires a Doctor of Medicine or Osteopathy from an accredited school and a Pennsylvania medical license. The ideal candidate has 5-10 years of clinical experience and managed care experience.

Licensure, Certifications, and Clearances:

• Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)

UPMC is an Equal Opportunity Employer/Disability/Veteran

Seniority level

• Director

Employment type

• Full-time

Job function

• Other

Industries

• Hospitals and Health Care