Title: Medical Director, Utilization Management Location: Pittsburgh United States Status: Full-Time Regular/Temporary: Regular Shift: Day Job Work Arrangement: Remote Facility: UPMC Health Plan Department: Medical Director Service Union Position: No Salary Range: $ 0.0-0.0 USD Job Description: Purpose: 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. Oversees adherence to quality and utilization standards through committee delegations, and further establishes an effective working relationship between UPMC Health Plan's Network and its physicians, hospitals and other providers. 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: - Provide leadership direction for provider credentialing processes. - Physicians must devote sufficient time to the CHC-MCO to provide timely medical decisions, including after-hours consultation, as needed - Provide leadership and direction in meeting Quality Improvement and Care Management goals directed at improvements in member health status outcomes and established business strategies. - Provide expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan. - 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. - 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. - Responsible for reporting the communication of reportable communicable diseases in accordance with statute. - Interacts 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 the designated county/municipal health department staff to appropriately report reportable conditions in accordance with 28 Pa. Code 27.1 et seq. - Daily interventions support implementation of the Health Plan's Quality Improvement and Care Management Programs. - Represent the Health Plan in external accreditation and certification activities. - Act as first level physician reviewer for all cases referred by the Quality Improvement and Care Management Departments. - Daily activities support adherence to quality and utilization standards, and establish an effective working relationship between UPMC Health Plan's Network and its physicians, hospitals and other providers. - Doctor of Medicine or Doctor of Osteopathy from an accredited school Required - The ideal candidates will have a minimum of 5-10 years of clinical experience - Managed Care experience preferred - Preference will be given to candidates with board certification in Internal Medicine, Family Medicine, Geriatric Medicine or Emergency Medicine Licensure, Certifications, and Clearances: - Doctor of Medicine (MD OR Doctor of Osteopathic Medicine (DO - PA Medical License UPMC is an Equal Opportunity Employer/Disability/Veteran

• Design and implement scalable clinical operations processes, governance structures, vendor oversight models, and study management practices. • Establish the framework for how Renasant executes clinical trials as the organization grows. • Evaluate which functions should be maintained internally and which should be outsourced to CROs and specialized vendors. • Support future hiring plans and organizational design for Clinical Operations. • Support clinical studies involving genetically defined patient populations and genetic confirmation of diagnosis. • Develop operational approaches for patient identification, screening, and enrollment in rare disease populations. • Establish relationships with nephrology investigators, rare disease centers of excellence, patient advocacy organizations, and specialty testing partners. • Support global recruitment strategies where patient populations may be geographically dispersed. • Lead selection, oversight, and performance management of CROs, central laboratories, genetic testing vendors, imaging vendors, and specialty providers. • Establish clear governance structures and accountability measures for external partners. • Ensure external partners function as extensions of the Renasant team while maintaining high standards of quality, speed, and execution. • Serve as the primary Clinical Operations leader responsible for transitioning programs from preclinical and translational development into clinical execution. • Partner with DMPK, Toxicology, and Research teams to develop operationally feasible clinical development plans. • Identify operational risks, and execution challenges before studies enter the clinic. • Provide operational input into protocol development, patient identification approaches, and study feasibility. • Build operational strategies for first-in-human and proof-of-concept studies. • Lead feasibility assessments, country selection, site identification, enrollment planning, and vendor selection activities. • Develop study timelines, budgets, risk mitigation plans, and execution strategies. • Oversee and execute study startup through database lock and study closeout.

• Serve as both a practicing clinician and a clinical leader — directly managing a team of Clinical Leads, driving clinical quality and performance across the medical group, and acting as a key voice in how AI is responsibly integrated into patient care • Partner with the medical group President to execute clinical vision and strategy, setting expectations for performance, culture, and leadership development • Implement and monitor QA programs, clinical review processes, and evidence-based clinical standards • Monitor clinical outcomes and patient safety metrics, leading remediation efforts as needed • Ensure compliance with state and federal regulations, including PC-MSO structures, multi-state CPOM rules, and HIPAA data security standards • Provide direct patient care to fill staffing gaps during periods of high demand, ensuring continuity of care • Collaborate across Operations, Product, Engineering, Legal, and Compliance to support safe, effective AI integration into clinical care

• Assisting psychiatry clinicians with onboarding and account setup • Troubleshoot EHR-related issues for psychiatry clinicians • Assist with questions that arise from psychiatry clinicians with an emphasis on troubleshooting and following up on e-prescribing issues that may arise • Triage questions/requests to direct to clinical and/or operational leadership, as appropriate, with timely communication • Assist in managing high-volume email accounts to answer questions for psychiatry clinicians • Provide additional administrative support to medical staff, Regional Operations Directors, and program leadership • Following up with psychiatry clinicians on clinical and administrative documentation • Multidisciplinary care coordination with the ability to problem solve, troubleshoot, and track key projects and issues in a timely manner. • Assist in maintaining SOPs for all aspects of the MCD position • Provide as needed support to Medical Assistants with responsibilities including Labs, Prior Authorizations, Paperwork Requests and Refill Requests during high volume period • Support Psych program leadership with ad hoc projects