Remote Medical Director, Utilization & Quality Leadership

UPMC; Pittsburgh (Allegheny County); On-site; USD 180,000 - 240,000; Full time

Job summary

UPMC Health Plan is seeking a Medical Director to join the Utilization Management team. This fully remote role oversees credentialing leadership and ensures high-quality care for plan members.

The ideal candidate has 10+ years of clinical experience and board certification in Internal Medicine, Family Medicine, Geriatrics, or Emergency Medicine, with managed care exposure. Pennsylvania licensure is required for MD/DO.

Qualifications

• MD or DO degree from an accredited medical school.
• Board certification in Internal Medicine, Family Medicine, Geriatrics or Emergency Medicine preferred.
• Managed care experience preferred.

Responsibilities

• Provide leadership direction for provider credentialing processes.
• Oversee utilization management and quality improvement activities to improve member health outcomes.
• Educate network providers on clinical guidelines, pathways, protocols, and standards.
• Represent the Health Plan in external accreditation and certification activities.
• Act as first-level physician reviewer for cases referred by Quality Improvement and Care Management.

Skills

Clinical leadership

Utilization management

Quality improvement

Credentialing

Education

MD

DO

Job description

UPMC Health Plan is seeking a Medical Director to join the Utilization Management team. This fully remote role oversees credentialing leadership and ensures high-quality care for plan members.

The ideal candidate has 10+ years of clinical experience and board certification in Internal Medicine, Family Medicine, Geriatrics, or Emergency Medicine, with managed care exposure. Pennsylvania licensure is required for MD/DO.