Highmark Inc. is seeking a physician reviewer to ensure utilization management duties meet current clinical standards. You will review escalated cases electronically and, when needed, via telephonic peer discussions, applying Medical Policy criteria to assess medical necessity and appropriateness. As a member of the CMDM multidisciplinary team, you will advise on high‑risk cases, participate in protocol development, and support special projects while adhering to NCQA, URAC, CMS, DOH, and DOL #J-18808-Ljbffr
Medical Director, Utilization & Care Management in Kent employer: Highmark Health
Highmark Health is an exceptional employer that prioritises employee growth and development within the dynamic healthcare sector. With a collaborative work culture and a commitment to innovation, employees are empowered to lead impactful projects while enjoying comprehensive benefits and a supportive environment in Pennsylvania. Join us to make a meaningful difference in healthcare while advancing your career.
