Philadelphia, PA

The Medical Director will provide medical leadership for utilization management, cost containment, and medical quality improvement activities.The candidate will perform medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services.

  • Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership.
  • Utilizes the services of medical and pharmacy consultants for reviewing complex cases and medical necessity appeals.
  • Participates in provider network development and new market expansion as appropriate.
  • Assists in the development and implementation of physician education with respect to clinical issues and policies.
  • Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components.
  • Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care.


  • MD
  • Must be licensed to practice in the state.
  • Must be Board-certified in his/her medical specialty.
  • Must be clear of any sanctions by the applicable state or Office of the Inspector General.
  • Must not be prohibited from participating in any Federally or State funded healthcare programs.
  • Full-time experience as an administrator in a Medicare or state-level Medicaid program, Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), large Health Care Organization, health plan or any combination thereof.
  • 8+ years’ experience in senior management and or Medical Director experience; 7 years Utilization Review and Case management experience.
  • 5+ years of medical management and general management experience in a managed care environment is preferred.
  • Primary care discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer in a Managed Care Plan preferred.
  • Utilization management experience preferred. Minimum five years of progressive business experience.

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Contact us for more info:
Rebecka Boyd