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Medical Director
Job
Alpha Business Solutions
Remote
$270,400 Salary, Full-Time
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Job Description
Medical Director Alpha Business Solutions - 2.3 Philadelphia, PA Job Details Contract $120 - $140 an hour 19 hours ago Benefits Disability insurance Dental insurance Vision insurance Life insurance Qualifications Teamwork Program development Quality management Organizational skills Medical License Internal medicine Full Job Description Position Summary The Medical Director serves as a physician leader responsible for promoting the delivery of safe, effective, and cost-efficient medical care across health plans administered by the organization and its subsidiaries. This role supports clinical and operational initiatives by providing expert medical oversight, evidence-based decision-making, and collaboration with internal and external stakeholders. The Medical Director plays a key role in Utilization Management, Care Management, and other business activities where physician involvement is essential to ensuring quality outcomes, regulatory compliance, and appropriate resource utilization. Candidate should have active, unrestricted, and unencumbered Pennsylvania medical license Candidate should be located in tristate, which includes PA, NJ and DE Key Responsibilities Utilization Management & Clinical Review Provide physician leadership and support for Utilization Management and Care Management programs. Review and render coverage and payment determinations based on health plan benefits, medical necessity criteria, and contractual agreements with participating providers. Apply sound clinical judgment using evidence-based guidelines and industry best practices. Ensure decisions align with principles of quality management, patient safety, population health, and cost-effective care delivery. Participate in peer-to-peer consultations and medical necessity reviews as needed. Clinical Leadership Collaborate with senior leadership, management teams, and clinical staff to support organizational goals. Promote high-quality, cost-effective healthcare across all lines of business. Provide clinical expertise on healthcare policy, utilization trends, and quality improvement initiatives. Support strategic programs designed to improve member outcomes and healthcare value. Stakeholder Collaboration Partner with internal departments and external healthcare providers to facilitate effective care delivery. Foster productive relationships with provider networks and healthcare organizations. Contribute to clinical program development and operational excellence initiatives. Required Qualifications Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degree from a medical or osteopathic school recognized by the American Association of Medical Colleges (AAMC), American Osteopathic Association (AOA), or World Health Organization (WHO). Active, unrestricted, and unencumbered Pennsylvania medical license. Current board certification through the American Board of Medical Specialties (ABMS) or the American Osteopathic Board of Medical Specialties (AOBMS). Family Medicine or Internal Medicine board certification preferred. Ability to successfully complete the organization's credentialing process. Preferred Experience & Skills Strong knowledge of clinical medicine and healthcare delivery systems. Experience in Utilization Management, Care Management, or Health Plan Medical Management. Understanding of population health, quality improvement, patient safety, and health insurance operations. Excellent communication, collaboration, and leadership skills. Ability to make objective, evidence-based clinical decisions in a fast-paced environment. Work Location Fully Remote This position is designated as fully remote. The incumbent is not required to report to a physical office location; however, work must be performed within the Tri-State Area, including: