Per Diem Medical Director Utilization Management

About the Role

Amerihealth Caritas seeks a Per Diem Medical Director for Utilization Management in Pennsylvania. This role supports clinical review, appeals, and quality oversight within the health plan. The position reports to the Senior Medical Director of UM and involves up to 15 hours per week including rotating weekend and evening coverage.

Key Responsibilities

• Perform daily medical reviews and appeals.
• Participate in appeal panels and physician peer review.
• Implement evidence-based practice guidelines.
• Oversee clinical care quality for network providers.
• Ensure compliance with medical policies and regulatory guidelines.
• Collaborate with multidisciplinary teams and attend case management meetings.

Requirements

• MD degree.
• Licensed to practice in Pennsylvania as a medical director; additional state licenses required within 30 days.
• Board-certified in Internal Medicine or Family Medicine.
• 1 to 3 years of health plan experience.
• Clear of sanctions and eligible for federally/state funded healthcare programs.

Benefits & Compensation

• Competitive pay.
• Flexible work solutions including remote options.
• Paid time off including holidays and volunteer events.
• Health insurance coverage for you and dependents starting Day 1.
• 401(k) retirement plan.
• Tuition reimbursement.

Work Schedule

• Up to 15 hours per week.
• Includes rotating weekend and evening coverage.

Amerihealth Caritas is a mission-driven organization committed to building healthier communities. This role offers flexibility and meaningful leadership in medical management.