Utilization Review Regional Medical Director

Utilization Review Regional Medical Director

pittsburgh, PA 15233
Income Potential:
Up to $275,000.00*
Signing Bonus:
Loan Forgiveness:
Job Number:
Posted Date:
Recruiter's Name:
Daniel Kalkhoff
Contact Number:
(800) 876-0500
Merritt Hawkins

Job Description & Requirements
Start Date:
Available Shifts:
Full Time
Job Type:

Practice Description
  • Partner with cross-functional teams and senior leaders to maintain industry leadership in innovative health management strategies and the field of post-acute care.
  • Serve as the expert on clinical competencies, take part in sales meetings and maintaining relationships with client CMO’s post-sale to ensure continued service and support from the clinical side of the house.
  • Use a metrics-driven approach to drive the successful implementation and adoption of clinical protocols across care settings
  • Contribute to and collaborate with health services team to drive strategic initiatives, address areas of concern, and monitor progress toward goals
  • Perform ongoing reviews and assessments of Care Management Model and collaborate with the health services team to improve quality outcomes and drive down costs
  • Re-evaluate and assess on an ongoing basis the Readmission Avoidance Program and make recommendations for improvement
  • Provide input on local needs for analytics and client services teams in order to better enhance our clients' product and services
  • Meet regularly with  medical directors that report to you to review care coordination issues, develop collaborative intervention plans, and share ideas about network management issues
  • Collaborate with medical directors and client services team to ensure a coordinated approach to delivery system providers
  • Communicate effectively with network and non-network providers to ensure the successful administering of our services
  • Respond to clinical inquiries and serve as a non-promotional medical contact point for various healthcare providers
  • Provide leadership and guidance to maximize cost management through close coordination with all network and provider contracting
  • Interact, communicate and collaborate with network and community physicians, hospital leaders, and other vendors regarding care and service for enrollees, educating them on designated care plans and ensuring the successful implementation of programs in the field
This position is located in northern Pittsburgh and will require you to be in the office 3-4 days of the week. 

Required Qualifications

MD or DO required. Experience practicing in an acute inpatient environment. Experience dealing with managed care organizations. Experience with the Pittsburgh, PA medical landscape.

About The Company

Merritt Hawkins, an AMN Healthcare company, is a permanent physician placement service that fills more physician jobs than any other firm. In addition to being the nation’s leader in physician employment search and consulting services, Merritt Hawkins also recruits and places select allied health professionals. AMN Healthcare is an EEO/AA/Disability/Protected Veteran Employer.  We encourage minority and female applicants to apply.