UPMC logo
UPMC

UPMC is an Equal Opportunity Employer/Disability/Veteran.

Medical Director, Utilization Management

Medical DirectorMedical DirectorFull TimeRemoteLeadTeam 10,001

Location

United States

Posted

4 days ago

Salary

0

Seniority

Lead

No structured requirement data.

Job Description

Medical Director, Utilization Management

UPMC

Role Description The UPMC Health Plan is seeking a Medical Director to join our Utilization Management team. The ideal candidate will have a minimum of 10 years of clinical experience, as well as experience working with a Health Plan. The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC Health Plan members. This fully remote role will be responsible for: - Assuring physician commitment and delivery of comprehensive high-quality health care to UPMC Health Plan members. - Overseeing adherence to quality and utilization standards through committee delegations. - Establishing effective working relationships between UPMC Health Plan's Network and its physicians, hospitals, and other providers. Responsibilities - Provide leadership direction for provider credentialing processes. - Ensure physicians devote sufficient time to the CHC-MCO for timely medical decisions, including after-hours consultation as needed. - Lead and direct efforts in meeting Quality Improvement and Care Management goals aimed at improving member health status outcomes and established business strategies. - Provide expedited review and determination of medically pressing issues in accordance with established policies of the Health Plan. - Participate in daily utilization management and quality improvement review processes, including concurrent, prospective, and retrospective reviews, member grievances, provider appeals, and potential quality of care concerns. - Stay current with accepted standards and professional developments in quality improvement and utilization management. - Communicate and educate network providers regarding clinical guidelines, pathways, protocols, and standards related to quality and utilization processes. - Report the communication of reportable communicable diseases in accordance with statute. - Interact with physicians regarding opportunities to improve member satisfaction and compliance with Utilization Management and Quality Improvement policies and procedures. - Work with the DOH State and District Office Epidemiologists in partnership with designated county/municipal health department staff to report reportable conditions in accordance with 28 Pa. Code 27.1 et seq. - Support implementation of the Health Plan's Quality Improvement and Care Management Programs through daily interventions. - Represent the Health Plan in external accreditation and certification activities. - Act as the first level physician reviewer for all cases referred by the Quality Improvement and Care Management Departments. - Support adherence to quality and utilization standards and establish effective working relationships between UPMC Health Plan's Network and its physicians, hospitals, and other providers. Qualifications - Doctor of Medicine or Doctor of Osteopathy from an accredited school (Required). - Minimum of 5-10 years of clinical experience (ideal candidates). - Managed Care experience preferred. - Preference for candidates with board certification in Internal Medicine, Family Medicine, Geriatric Medicine, or Emergency Medicine. Requirements - Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO). - PA Medical License. Benefits - Premier benefits package designed to care for your total well-being — physically, emotionally, and financially. - Endless opportunities for career advancement and growth. Company Description UPMC is an Equal Opportunity Employer/Disability/Veteran.

Related Categories

Related Job Pages

More Medical Director Jobs

easykind logo

Telehealth Medical Practitioners & Nurse Practitioners

easykind

easykind is an alternative healthcare clinic offering cost-effective service to everyday Australians.

Part TimeRemoteTeam 51-200H1B No Sponsor

Role Description At easykind, we’re building a modern healthcare experience that puts patients first. We’re looking for compassionate Medical Practitioners and Nurse Practitioners to join our growing telehealth team, delivering high-quality, evidence-informed alternative medicine consultations to patients across Australia. - Conduct comprehensive telehealth consultations - Assess patient suitability - Develop individualised treatment plans - Provide ongoing clinical care within a supportive multidisciplinary environment This role offers genuine flexibility without compromising clinical standards. We provide comprehensive paid onboarding, structured clinical education, ongoing mentoring, and access to experienced clinical leaders who will support you every step of the way. Qualifications - Current unrestricted registration as a Medical Practitioner or Nurse Practitioner in Australia - Current AHPRA registration with authority to prescribe Schedule 8 medications - Excellent communication and consultation skills - Strong clinical judgement and ethical decision-making - Thorough understanding of clinical governance and regulatory requirements - Confidence using technology and adapting to new digital platforms - Ability to work autonomously while collaborating effectively within a multidisciplinary team Requirements - Work when it suits you and create a schedule that works around your lifestyle - Minimum commitment of just 15 hours per week, with opportunities to increase your hours over time - Fully remote consulting with patients from anywhere in Australia - No commuting, no consulting rooms, and no administrative overhead Benefits - Competitive remuneration that recognises your clinical expertise and experience - Paid onboarding with comprehensive clinical education and evidence-informed prescribing training - Support from experienced clinical leaders - Work at the forefront of a rapidly growing healthcare industry - Join a collaborative team that genuinely supports each other - Join a company nominated for LinkedIn’s Top Startups 2025

Australia
120 - 225 / hour
Access TeleCare logo

Director Client Services – Healthcare

Access TeleCare

Better Outcomes. Powered by Intelligence.

Full TimeRemoteTeam 201-500Since 2004H1B No Sponsor

• Own the overall client experience in your assigned territory and manage the customer relationship post implementation • Articulate service line value and facilitate resolution to customer client inquiries • Work cross-functionally with our Sales, Marketing, IT, Implementation, Operations, Clinical and Contracts Departments to drive client initiatives within the organization • Perform monthly calls and quarterly business reviews with your book of business and onsite client visits to maintain client health and strengthen the client partnership • Directly influence our clients’ experiences at the executive leadership level and act as the escalation point for any satisfaction issues within the relationship • Balance the role as a client advocate and strong representative of Access TeleCare with minimal supervision • Frequent travel within assigned territory & corporate offices • Travel 30-40% within territory & corporate offices • Other duties as assigned

United States

Director, Finance

Aegon Ltd.

Aegon Ltd. provides various financial services, such as life insurance, pensions, asset management, and retirement planning, aimed at empowering individuals to

Title: Director, Finance - Group Consolidation Location: Cedar Rapids, Iowa Denver, Colorado Baltimore, Maryland Philadelphia, Pennsylvania Job Description: Job Family Finance - General About Us At Transamerica, hard work, innovative thinking, and personal accountability are qualities we honor and reward. We understand the potential of leveraging the talents of a diverse workforce. We embrace an environment where employees enjoy a balance between their careers, families, communities, and personal interests. Ultimately, we appreciate the uniqueness of a company where talented professionals work collaboratively in a positive environment - one focused on helping people look forward and plan for the best life possible while providing tools and solutions that make it easier to get there. Who We Are We believe everyone deserves to live their best life. More than a century ago, we were among the first financial services companies in America to serve everyday people from all walks of life. Today, we're part of an international holding company, with millions of customers and thousands of employees worldwide. Our insurance, retirement, and investment solutions help people make the most of what's important to them. We're empowered by a vast agent network covering North America, with diversity to match. Together with our nonprofit research institute and foundation, we tune in, step up, and are a force for good - for our customers and the communities where we live, work, and play. United in our purpose, we help people create the financial freedom to live life on their terms. What We Do Transamerica is organized into three distinct businesses. These include 1) World Financial Group, including Transamerica Financial Advisors, 2) Protection Solutions and Savings & Investments, comprised of life insurance, annuities, employee benefits, retirement plans, and Transamerica Investment Solutions, and 3) Financial Assets, which includes legacy blocks of long term care, universal life, and variable and fixed annuities. These are supported by Transamerica Corporate, which includes Finance, People and Places, General Counsel, Risk, Internal Audit, Strategy and Development, and Corporate Affairs, which covers Communications, Brand, and Government and Policy Affairs. Transamerica employs nearly 7,000 people. It's part of Aegon, an integrated, diversified, international financial services group serving approximately 23.9 million customers worldwide.* For more information, visit transamerica.com. Job Description Summary Provide strategic leadership and oversight for the Global Consolidation and Corporate Reporting function. Lead the governance, consolidation, reporting, and finance transformation activities necessary to deliver accurate, timely, and transparent financial information. Establish and maintain a scalable reporting operating model, strong control environment, and reporting governance framework that supports the Company's U.S. GAAP reporting objectives and enterprise financial reporting requirements. Job Description Responsibilities - Partner with domestic and international finance leaders to ensure consistent application of accounting policies and reporting requirements across legal entities and reporting segments. - Oversee accounting and reporting matters related to investments in subsidiaries and other legal entities, including consolidation conclusions, ownership changes, and organizational structure impacts. - Establish and maintain reporting calendars, reporting instructions, and data requirements supporting enterprise-wide financial reporting. - Provide leadership and oversight for consolidated financial reporting deliverables, ensuring the completeness, accuracy, and timeliness of reported results. - Serve as executive sponsor for consolidation and reporting systems, driving improvements in automation, data quality, controls, and reporting capabilities. - Lead interactions with executive management, external auditors, and other stakeholders regarding consolidated financial results, reporting matters, and key business developments. - Direct the design and execution of controls supporting the integrity of financial reporting and ensure timely remediation of identified issues. - Lead organizational planning, resource allocation, and talent development activities within the function. Qualifications - Bachelor's degree in accounting or finance, or equivalent experience - 12 years of accounting/finance experience including eight years of management experience - Extensive knowledge of assigned business area (e.g. investments, premiums, corporate finance) - Strong leadership and people management skills - Ability to effectively communicate, orally and in writing, to diverse audiences - Organizational and prioritization skills - Advanced computer skills in MS Office, Excel and financial business systems Preferred Qualifications - CPA/advanced degree - Experience within the insurance or financial services industry. - Experience supporting multinational reporting environments. - Experience leading complex financial reporting, consolidation, or controllership functions. Working Conditions - Hybrid (In Office: Tuesdays, Wednesdays & Thursdays) The Salary for this position generally ranges between $159,000 - $200,000 annually. Please note that the salary range is a good faith estimate for this position and actual starting pay is determined by several factors including qualifications, experience, geography, work location designation (in-office, hybrid, remote) and operational needs. Salary may vary above and below the stated amounts, as permitted by applicable law. Additionally, this position is typically eligible for an Annual Bonus based on the Company Bonus Plan/Individual Performance and is at the Company's discretion. Disclaimer: Beware of fake job offers! We've been alerted to scammers impersonating Transamerica recruiters, particularly for remote positions. Please note: - We will never request personal information such as ID or payment for equipment upfront. - Official offers are sent via DocuSign following a verbal offer-not through text or email. This job description is not a contract of employment nor for any specific job responsibilities. The Company may change, add to, remove, or revoke the terms of this job description at its discretion. Managers may assign other duties and responsibilities as needed. In the event an employee or applicant requests or requires an accommodation to perform job functions, the applicable HR Business Partner should be contacted to evaluate the accommodation request. What We Offer For eligible employees, we offer a comprehensive benefits package designed to support both the personal and financial well-being of our employees. Compensation Benefits - Competitive Pay - Bonus for Eligible Employees Benefits Package - Pension Plan - 401k Match - Employee Stock Purchase Plan - Tuition Reimbursement - Disability Insurance - Medical Insurance - Dental Insurance - Vision Insurance - Employee Discounts - Career Training & Development Opportunities Health and Work/Life Balance Benefits - Paid Time Off starting at 160 hours annually for employees in their first year of service. - Ten (10) paid holidays per year (typically mirroring the New York Stock Exchange (NYSE) holidays). - Be Well Company holistic wellness program, which includes Wellness Coaching and Reward Dollars - Parental Leave - fifteen (15) days of paid parental leave per calendar year to eligible employees with at least one year of service at the time of birth, placement of an adopted child, or placement of a foster care child. - Adoption Assistance - Employee Assistance Program - Back-Up Care Program - PTO for Volunteer Hours - Employee Matching Gifts Program - Employee Resource Groups - Inclusion and Diversity Programs - Employee Recognition Program - Referral Bonus Programs Inclusion & Diversity We believe our commitment to diversity and inclusion creates a work environment filled with exceptional individuals. We're thrilled to have been recognized for our efforts through the Human Rights Campaign Corporate Equality Index, Dave Thomas Adoption Friendly Advocate, and several Seramount lists, including the Inclusion Index, 100 Best Companies for Working Parents, Best Companies for Dads, and Top 75 Companies for Executive Women. To foster a culture of inclusivity throughout our workforce, workplace, and marketplace, Transamerica offers a wide range of diversity and inclusion programs. This includes our company-sponsored, employee-driven Employee Resource Groups (ERGs), which are formed around a shared interest or a common characteristic of diversity. ERGs are open to all employees. They provide a supportive environment to help us better appreciate our similarities and differences and understand how they benefit us all. Giving Back We believe our responsibilities extend beyond our corporate walls. That's why we created the Aegon Transamerica Foundation in 1994. Through a mix of financial grants and the volunteer efforts of our employees, the foundation supports nonprofit organizations focused on the things that matter most to our people in the communities where we live and work. Transamerica's Parent Company Aegon acquired the Transamerica business in 1999. Since its start in 1844, Aegon has grown into an international company serving more than 23.9 million people across the globe.* It offers investment, protection, and retirement solutions, always with a clear purpose: Helping people live their best lives. As a leading global investor and employer, the company seeks to have a positive impact by addressing critical environmental and societal issues, with a focus on climate change and inclusion and diversity. - As of December 31, 2023

Pennsylvania + 3 moreAll locations: Pennsylvania | Iowa | Colorado | Maryland
$159K - $200K / year
Part TimeRemoteTeam 1,001-5,000H1B No Sponsor

• Responsible for clinical quality and administrative activities in Ambulatory Surgery Centers (ASC) • Execute quality and safety plans and center policies • Evaluate compliance with applicable CMS and State regulations • Monitor clinical activities and overall administrative functions • Develop and monitor center action plans

Tennessee