Medical Director

• The Medical Director serves as a physician leader responsible for promoting the delivery of safe and effective medical care in the most cost-effective way for the health plans offered by client and subsidiaries. 
• There are multiple elements of discrete work that may fall under the role including:
• Utilization Management
• The physician directly supports Utilization Management and Care Management and other business activities where involvement of a physician is determined to be in the best interest of Independence.
• The Medical Director will be responsible for rendering coverage and payment determinations based on the terms and conditions of the health plans for which Independence serves as claims administrator, and on the terms and conditions of contracts executed between Independence and networks of participating health care providers.
• The Medical Director will exercise sound decision making based on clinical guidelines for best practices, a strong knowledge of clinical medicine, the practical realities of the delivery of health care in the state of Pennsylvania, and a thorough understanding of the principles of population health, quality management, patient safety and health insurance.
• The Medical Director will be expected to effectively collaborate with professional staff, senior leadership, management and associates and with external partners to promote the delivery of cost-effective health care across all lines of business.

Key Requirements and Technology Experience: 

• We require a Medical Doctor or Doctor of Osteopathy degree from a medical school or osteopathic medical school recognized by the American Association of Medical Colleges (AAMC), the American Osteopathic Association (AOA), or the World Health Organization (WHO).
• Has an unrestricted and unencumbered Pennsylvania license to practice clinical medicine or osteopathic medicine.
• Current Board Certification by ABMS or AOBMS - family medicine or internal medicine board certification preferred 
• Ability to successfully complete client credentialing process