REMOTE Medical Director Locum - Pennsylvania!

Job description

Medical Director – Utilization Management

Overview:
Physician leader responsible for utilization review, quality oversight, and medical management initiatives. Works closely with senior leadership to ensure appropriate, high-quality, and cost-effective care delivery.

Key Responsibilities

Perform utilization reviews for inpatient, outpatient, pharmacy, and dental services, including peer-to-peer discussions

Participate in and support Utilization Management and Pharmacy & Therapeutics committees

Advise senior leadership on healthcare utilization and medical necessity

Participate in care management, disease management, and admission rounds

Support NCQA accreditation and utilization, quality, and disease management programs

Assist with development and revision of clinical guidelines, policies, and procedures

Collaborate with finance and analytics teams to improve utilization and outcomes data

Represent medical management internally and externally as directed

Lead or support initiatives to improve utilization and quality metrics

Requirements

MD or DO

Unrestricted Pennsylvania medical license

Board Certified

Minimum 5 years post-residency clinical experience

Managed care experience with utilization management responsibilities

MBA or similar graduate business degree preferred

Skills

Strong leadership, communication, and organizational skills

Excellent decision-making and conflict resolution abilities

Proven project management, analytical, and negotiation skills

Working knowledge of utilization, quality, and care management principles