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Remote Supervisor Utilization Management Jobs in Pennsylvania

Bcbsa

Director, Trade Client Relations

Indiana, PA · On-site +1

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Bcbsa

$155K - $175K/yr

... and utilization management strategies * Client Relations - Serve as Trade's primary point of ... Work is generally performed in a remote setting. #LI-Remote $155,000.00 - $175,000.00 This is the ...

Alpine Physician Partners

Director, Affordability Alpine Physician Partners | Remote-Flexible The Role This role is ... Design and manage programs to reduce avoidable admissions, readmissions and ED utilization in ...

InfoCision

Entry Level Supervisor-Remote

New Castle, PA · Remote

$30K/yr

Entry-Level Supervisor (Remote) $30,000/year (flexible based on experience) Full-Time | Afternoon ... No formal management experience? That's okay-we'll help you build it. What You'll Do * Coach and ...

InfoCision

Entry Level Supervisor-Remote

New Castle, PA · Remote

$30K/yr

Entry-Level Supervisor (Remote) $30,000/year (flexible based on experience) Full-Time | Afternoon ... No formal management experience? That's okay-we'll help you build it. What You'll Do * Coach and ...

DaVita

RN Case Manager- IKC, Remote

Birdsboro, PA · On-site +1

$66K/yr

Hybrid-Remote. Work from home (telehealth) and travel within an assigned geography for in-person ... utilization management experience * Spanish-speaking preferred in some markets DaVita IKC ...

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Remote Supervisor Utilization Management information

What is the difference between Remote Supervisor Utilization Management vs Remote Utilization Review Nurse?

AspectRemote Supervisor Utilization ManagementRemote Utilization Review Nurse
CredentialsRN, often with management or supervisor certificationsRN, with clinical review certifications
Work EnvironmentSupervises teams, manages utilization processes remotelyPerforms clinical reviews, assesses patient necessity remotely
Employer & Industry UsageHealth insurance companies, managed care organizationsInsurance companies, third-party administrators
Primary FocusOverseeing utilization management operationsConducting clinical utilization reviews

Remote Supervisor Utilization Management roles focus on overseeing utilization management teams and processes, ensuring compliance and efficiency. In contrast, Remote Utilization Review Nurses primarily perform clinical assessments to determine the necessity of services. Both roles require RN credentials but differ in responsibilities and scope within the utilization management field.

What are the most commonly searched types of Supervisor Utilization Management jobs in Pennsylvania?

The most popular types of Supervisor Utilization Management jobs in Pennsylvania are:

What are popular job titles related to Remote Supervisor Utilization Management jobs in Pennsylvania?

For Remote Supervisor Utilization Management jobs in Pennsylvania, the most frequently searched job titles are:

What job categories do people searching Remote Supervisor Utilization Management jobs in Pennsylvania look for?

The top searched job categories for Remote Supervisor Utilization Management jobs in Pennsylvania are:

What cities in Pennsylvania are hiring for Remote Supervisor Utilization Management jobs?

Cities in Pennsylvania with the most Remote Supervisor Utilization Management job openings:

Remote Supervisor Utilization Management jobs near you
Infographic showing various Remote Supervisor Utilization Management job openings in Pennsylvania as of August 2026, with employment types broken down into 83% Full Time, and 17% Part Time. Highlights an 100% Remote job distribution.

Medical Director, Utilization Management

UPMC Health Plan

Pittsburgh, PA • Remote

Full-time

Re-posted 25 days ago

Job description

Purpose:
The UPMC Health Plan is seeking a Medical Director to join our Utilization Management team. The ideal candidate will have a minimum of 10 years of clinical experience, as well as experience working with a Health Plan.

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
  • 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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