Medical Director

Required Qualifications

• MD or DO degree.
• Minimum of 5 years of direct patient care experience.
• Board certification through an ABMS- or AOA-recognized specialty board.
• Active medical license in Pennsylvania, New York, or West Virginia.
• Strong utilization management (UM) experience on the health insurance/payer side is highly preferred. Hospital-based UM experience alone is not sufficient.
• Knowledge of managed care, case management, and clinical decision-making.
• Strong analytical, communication, and collaboration skills.

Preferred Qualifications

• Master's degree in Business Administration (MBA), Management, or Public Health (MPH).
• At least 1 year of medical management experience with a health insurance plan.
• Experience using MCG or InterQual criteria.

Additional Requirements

• Must successfully complete the Medical Director Assessment.
• Expected to review 55+ cases per 8-hour workday.
• Experience with Predictal and Beacon review systems is relevant.
• Candidates must be categorized as either Behavioral Health or Non-Behavioral Health (Physical Health) during submission.