Pennsylvania Licensed Medical Director

Responsible for assuring physician commitment and delivering comprehensive high-quality health care to members, the full-time Pennsylvania Licensed Medical Director will lead utilization management processes and quality improvement initiatives in a fully remote capacity. Key responsibilities Provide leadership direction for provider credentialing processes and ensure adherence to quality and utilization standards Participate in daily utilization management and quality improvement reviews, including concurrent, prospective, and retrospective assessments Communicate clinical guidelines and standards to network providers while representing the Health Plan in external accreditation activities Required qualifications Doctor of Medicine (MD) or Doctor of Osteopathy (DO) from an accredited school Minimum of 5-10 years of clinical experience Managed care experience preferred Board certification in Internal Medicine, Family Medicine, Geriatric Medicine, or Emergency Medicine is preferred Valid Pennsylvania Medical License