Physician / Administration / Delaware / Permanent / Medical Director
Highmark Health
Not Specified, DE, USA
Not Specified, DE, USA
- Healthcare
- Full-time
- Medical Director
- Utilization Management
- Clinical Standards
The Medical Director leads the physician team to ensure utilization management aligns with current clinical standards. They review escalated medical cases electronically to determine the necessity and appropriateness of requested treatments based on medical policy criteria. This role combines clinical expertise with administrative responsibilities to optimize patient care and resource use.
Company : Highmark Inc. Job Description : JOB SUMMARY This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most current clinical standards. The incumbent reviews escalated cases electronically and using Medical Policy criteria sets to evaluate the medical necessity and appropriateness of the requested treatment of service.




