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UPMC Health Plan

UM Care Manager (RN)

Pittsburgh, PA · On-site

UPMC Health Plan is hiring a full-time UM Care Manager to support our UM Clinical Operations team. This role will primarily work Monday - Friday standard daylight hours, with occasional Saturday ...

UPMC Health Plan

Account Coordinator - Hybrid

Pittsburgh, PA · Hybrid

$19.50 - $25.25/hr

UPMC Health Plan and WorkPartners is hiring a full-time Account Coordinator to join the Absence Client Services team. This role follows a hybrid work structure, with three days per week in the office ...

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How much do upmc health plan jobs pay per hour?

As of Jul 15, 2026, the average hourly pay for upmc health plan in the United States is $35.21, according to ZipRecruiter salary data. Most workers in this role earn between $24.28 and $47.36 per hour, depending on experience, location, and employer.

What are the key skills and qualifications needed to thrive in the Upmc Health Plan position, and why are they important?

To thrive at UPMC Health Plan, candidates typically need a background in healthcare administration, insurance operations, customer service, or clinical support, often supported by relevant degrees or certifications depending on the specific role. Familiarity with claims processing systems, healthcare management software, and compliance regulations such as HIPAA is often required. Exceptional interpersonal skills, problem-solving abilities, and adaptability are key soft skills that help build strong relationships with members, providers, and colleagues. These competencies are vital for delivering high-quality service, ensuring regulatory compliance, and supporting the organization's mission to improve health outcomes.

What types of career advancement opportunities are available at UPMC Health Plan?

UPMC Health Plan offers a variety of pathways for career growth, including opportunities for lateral moves into different departments, promotions to supervisory or managerial roles, and access to professional development resources. Employees are encouraged to participate in internal training programs, mentorship initiatives, and tuition assistance for further education. Advancement is often supported by demonstrated performance, willingness to learn new skills, and a commitment to the organization’s mission. Team members benefit from a collaborative work environment that recognizes and rewards initiative and leadership potential.

What is a UPMC Health Plan job?

A UPMC Health Plan job refers to a position within the insurance division of the University of Pittsburgh Medical Center (UPMC), which provides health coverage and related services. Employees in these roles may work in customer service, claims processing, healthcare management, or data analysis to support members and providers. UPMC Health Plan careers offer opportunities in both clinical and non-clinical fields, contributing to high-quality, affordable healthcare solutions.

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Upmc Health Plan jobs near you
Infographic showing various Upmc Health Plan job openings in the United States as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution, with an average salary of $73,232 per year, or $35.2 per hour.
Medical Director, Utilization Management

Medical Director, Utilization Management

UPMC Health Plan

Pittsburgh, PA • Remote

Other

Re-posted 11 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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