REMOTE - Medical Director for Managed Care Plans at Jefferson Health Plans

July 3, 2026

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<div>Job DetailsShape the future of healthcare delivery across one of the nation’s leading academic health systems. Jefferson Health is seeking a visionary Enterprise Medical Director to lead clinical strategy and utilization management for our integrated health plans and care management programs. This is a Full-Time Remote role.Job Description<ul><li>Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.</li><li>Perform utilization review for requests for services including but not limited to inpatient, outpatient, pharmacy and dental. This will include peer-to-peer discussions with providers.</li><li>Serve on and support the functions of committees including but not limited to the Utilization Management Committee and Pharmacy & Therapeutics Committee. </li><li>Advise the HealthCare Senior Management team regarding the utilization of health care services and interventions to promote the effective delivery of medically necessary services. </li><li>Participate and/or lead rounds including but not limited to disease management, care management or admissions.</li><li>Provide support for Plan accreditation processes (NCQA), Utilization, Quality and Disease Management programs.</li><li>Support ongoing activities in OB, pediatric, adolescent, adult preventative, and geriatric care.</li><li>Develop and or revise practice guidelines for acute and chronic care. </li><li>Develop and implement policies and procedures required to promote effective utilization management and achieve established targets.</li><li>Collaborate with HealthCare Economics and Finance to continuously improve the collection and use of data describing resource utilization and outcomes. </li><li>Represent HealthCare Management internally and externally at the direction of the VP Chief Medical Officer.</li><li>Develop and implement work plans to optimize appropriate utilization and quality targets as directed by the VP Chief Medical Officer.</li><li>Perform other job duties as assigned.</li><li>Required Education and Experience:</li><li>Medical Physician (MD or DO) required. </li><li>Pennsylvania Medical License without restriction.</li><li>Board Certification in a specialty (primary care preferred)</li><li>Graduate business degree is a plus (MBA, MMM, etc.). </li><li>Minimum 5 years post-residency experience in the clinical practice of medicine.</li><li>Managed care experience, with responsibility for utilization management.</li><li></li><li>Skills/Abilities:</li><li>Excellent organizational, interpersonal, time management and communications skills. </li><li>Strong leadership skills. </li><li>Strong conflict resolution and independent decision-making skills.</li><li>Expert project management ability. </li><li>Strong influencing, negotiation and analytical skills. </li><li>Working knowledge of PC based applications such as Excel, Access and Word.</li><li>Knowledge of the principles of Utilization, Quality and Care Management.</li></ul>Work ShiftWorkday Day (United States of America)Worker Sub TypeRegularEmployee EntityHealth Partners Plans, Inc.Primary Location Address1101 Market, Philadelphia, Pennsylvania, United States of AmericaBenefitsJefferson offers a comprehensive package of benefits for full-time and part-time colleagues, including medical (including prescription), supplemental insurance, dental, vision, life and AD&D insurance, short- and long-term disability, flexible spending accounts, retirement plans, tuition assistance, as well as voluntary benefits, which provide colleagues with access to group rates on insurance and discounts. Colleagues have access to tuition discounts at Thomas Jefferson University after one year of full time service or two years of part time service. All colleagues, including those who work less than part-time (including per diem colleagues, adjunct faculty, and Jeff Temps), have access to medical (including prescription) insurance.For more benefits information, please click </div>

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