Medical Director, Utilization Management & Care Strategy

Highmark Health; Washington (Washington County); On-site; USD 227,600 - 385,000; Full time

Job summary

Highmark Health is seeking a physician to join their utilization management team in Washington County, USA. The role involves evaluating treatment necessity for escalated cases and participating as part of a multidisciplinary team. Candidates should hold an MD or DO, with at least 5 years in clinical care and knowledge of medical management. The position offers a pay range of $227,600 to $385,000 depending on experience and qualifications, with no required travel and a primarily office-based environment.

Qualifications

• 5 years in Clinical, Direct Patient care (hospital, outpatient, or private practice).
• 1 year in Medical Management in a Health Insurance Plan preferred, strong knowledge of managed care industry.
• Awarded Board Certification at least once in specialty recognized by the American Board of Medical Specialties or the American Osteopathic Association.

Responsibilities

• Conduct electronic review of escalated cases against medical policy criteria.
• Participate in protocol and guidelines development to ensure consistency in the review process.
• Advise multidisciplinary teams on high-risk cases.

Skills

Critical Thinking

Case Management

Customer Service

Oral & Written Communication Skills

Collaboration

Listening

Telephone Skills

General Computer Skills

Clinical Software

Managed Care

Education

Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO)

Master's Degree in Business Administration/Management or Public Health

Job description

Highmark Health is seeking a physician to join their utilization management team in Washington County, USA. The role involves evaluating treatment necessity for escalated cases and participating as part of a multidisciplinary team. Candidates should hold an MD or DO, with at least 5 years in clinical care and knowledge of medical management. The position offers a pay range of $227,600 to $385,000 depending on experience and qualifications, with no required travel and a primarily office-based environment.