Medical Director
1 week ago
UPMC offers a premier benefits package, designed to care for your total well-being - physically, emotionally, and financially - paired with endless opportunities for career advancement and growth. Discover the culture, the teams, and the passions that drive us to make Life Changing Medicine happen.
Responsibilities:
- Actively participates in the daily utilization management and quality improvement review processes, including concurrent, prospective and retrospective reviews, member grievances, provider appeals, and potential quality of care concerns.
- Provide expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan.
- Keep current with accepted standards and professional developments in the areas of quality improvement and utilization management.
- Communicate and educate network providers regarding clinical guidelines, pathways, protocols, and standards related to quality and utilization processes.
- Interacts with physicians regarding opportunities to improve member satisfaction and compliance with Utilization Management and Quality Improvement policies and procedures.
- Contributes to process improvement within the Utilization Management department.
- Participates in activities to support policy decision making.
- Utilizes clinical experience to support departmental reviews.
This position requires a Doctor of Medicine or Doctor of Osteopathy from an accredited school, and a Pennsylvania medical license. The ideal candidate will have 5-10 years of clinical experience, as well as managed care experience.
Licensure, Certifications, and Clearances:
- Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)
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