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Medical Director at Highmark Health - ApplyBlast

Medical Director

Highmark Health

1 month ago

3.3 on Glassdoor

Remote

Full Time

Director

0 applicants

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About this role

The Medical Director will conduct electronic reviews of escalated cases, determine medical necessity, and ensure compliance with NCQA, URAC, CMS, DOH, and DOL regulations. They will also serve as a physician member of a multidisciplinary team, advising on high‑risk cases and participating in protocol development and special projects.

Responsibilities

Conduct electronic review of escalated cases against medical policy criteria
Participate as a physician member of multidisciplinary case management team
Develop protocols and guidelines to ensure consistent review process

Skills

Qualifications

Medical Doctor (MD)Doctor of Osteopathic Medicine (DO)Board Certification (ABMS or AOA)Active medical state licensure (PA, NY, or WV)Master's Degree in Business Administration/Management or Public Health