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From Home Upmc Health Plan Jobs (NOW HIRING)

UPMC Central PA

UPMC Health Plan has over 3 million members and is the largest health insurer in Western ... Individuals from all backgrounds are encouraged to apply. Candidates must be ABR board certified ...

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How much do from home upmc health plan jobs pay per hour?

As of Sep 2, 2026, the average hourly pay for from home upmc health plan in the United States is $50.19, according to ZipRecruiter salary data. Most workers in this role earn between $41.83 and $56.01 per hour, depending on experience, location, and employer.

What is the difference between From Home Upmc Health Plan vs From Home UPMC Health Plan Customer Service Representative?

AspectFrom Home Upmc Health PlanFrom Home UPMC Health Plan Customer Service Representative
CredentialsHigh school diploma or equivalent; health insurance knowledge preferredHigh school diploma or equivalent; customer service experience preferred
Work EnvironmentRemote, home-based office settingRemote, home-based office setting
Employer & IndustryUPMC Health Plan, healthcare insuranceUPMC Health Plan, healthcare insurance

Both roles are remote positions within UPMC Health Plan, focusing on healthcare insurance. The main difference lies in the job focus: From Home Upmc Health Plan may refer to broader roles within the organization, while From Home UPMC Health Plan Customer Service Representative specifically involves assisting members with inquiries. Both require similar credentials and offer remote work environments, making them comparable in industry and employer context.

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From Home Upmc Health Plan jobs near you
Infographic showing various From Home Upmc Health Plan job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 77% Full Time, 17% Part Time, and 5% Contract. Highlights an 95% Physical, 1% Hybrid, and 4% Remote job distribution, with an average salary of $104,392 per year, or $50.2 per hour.

Medical Director, Utilization Management (Remote)

UPMC Health Plan

Pittsburgh, PA • Remote

Full-time

Posted 4 days ago

Job description

Purpose:
The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC Health Plan members. This fully remote role will be responsible for assuring physician commitment and delivery of comprehensive high quality health care to UPMC Health Plan members. Oversees adherence to quality and utilization standards through committee delegations, and further establishes an effective working relationship between UPMC Health Plan's Network and its physicians, hospitals and other providers.

UPMC offers a premier benefits package, designed to care for your total well-being - physically, emotionally, and financially - paired with endless opportunities for career advancement and growth. Discover the culture, the teams, and the passions that drive us to make Life Changing Medicine happen.
Responsibilities:

  • Provide leadership direction for provider credentialing processes.
  • Physicians must devote sufficient time to the CHC-MCO to provide timely medical decisions, including after-hours consultation, as needed
  • Provide leadership and direction in meeting Quality Improvement and Care Management goals directed at improvements in member health status outcomes and established business strategies.
  • Provide expedited review and determination of medically pressing issues in accordance with the established policies of the Health Plan.
  • Actively participates in the daily utilization management and quality improvement review processes, including concurrent, prospective and retrospective reviews, member grievances, provider appeals, and potential quality of care concerns.
  • Keep current with accepted standards and professional developments in the areas of quality improvement and utilization management.
  • Communicate and educate network providers regarding clinical guidelines, pathways, protocols, and standards related to quality and utilization processes.
  • Responsible for reporting the communication of reportable communicable diseases in accordance with statute.
  • Interacts with physicians regarding opportunities to improve member satisfaction and compliance with Utilization Management and Quality Improvement policies and procedures.
  • Work with the DOH State and District Office Epidemiologists in partnership with the designated county/municipal health department staff to appropriately report reportable conditions in accordance with 28 Pa. Code 27.1 et seq.
  • Daily interventions support implementation of the Health Plan's Quality Improvement and Care Management Programs.
  • Represent the Health Plan in external accreditation and certification activities.
  • Act as first level physician reviewer for all cases referred by the Quality Improvement and Care Management Departments.
  • Daily activities support adherence to quality and utilization standards and establish an effective working relationship between UPMC Health Plan's Network and its physicians, hospitals and other providers.
  • Doctor of Medicine or Doctor of Osteopathy from an accredited school Required
  • The ideal candidates will have a minimum of 5-10 years of clinical experience
  • Managed Care experience preferred
  • Experience with Payor UM highly preferred
  • Preference will be given to candidates with board certification in Internal Medicine, Family Medicine, Geriatric Medicine or Emergency Medicine
    Licensure, Certifications, and Clearances:
  • Doctor of Medicine (MD) OR Doctor of Osteopathic Medicine (DO)
  • PA Medical License


UPMC is an Equal Opportunity Employer/Disability/Veteran

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