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Upmc Health Plan Remote Jobs (NOW HIRING)

UPMC Health Plan

Provider Advocate - Erie, PA

Erie, PA · On-site +1

$51K - $66K/yr

UPMC Health Plan is hiring a team of Provider Advocates to support the Provider Services department. This is a full-time hybrid position based in the Erie, PA area. While you'll primarily work ...

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How much do upmc health plan remote jobs pay per year?

As of Aug 27, 2026, the average yearly pay for upmc health plan remote in the United States is $150,761.00, according to ZipRecruiter salary data. Most workers in this role earn between $152,000.00 and $153,000.00 per year, depending on experience, location, and employer.

What is a UPMC Health Plan remote job?

A UPMC Health Plan remote job is a position with UPMC Health Plan that allows employees to work from home or another off-site location instead of commuting to a physical office. These roles can include customer service, case management, claims processing, IT, and other administrative or healthcare-related tasks. Remote positions offer flexibility and may require reliable internet access, effective communication skills, and the ability to work independently. UPMC Health Plan supports remote employees with virtual training, online resources, and collaboration tools to ensure effective job performance.

What are the typical responsibilities and collaboration methods for a remote role at UPMC Health Plan?

In a remote position at UPMC Health Plan, daily responsibilities may include interacting with members or providers via phone, email, or video platforms, processing healthcare claims, coordinating care, or supporting IT and administrative functions, depending on the specific role. Team collaboration is often facilitated through virtual meetings, shared digital workspaces, and regular check-ins with supervisors and colleagues. Remote employees are expected to maintain strong communication skills, be self-motivated, and proactively seek support when needed to ensure high-quality service and alignment with team goals.

What are the key skills and qualifications needed to thrive as a UPMC Health Plan remote employee, and why are they important?

To thrive in a UPMC Health Plan remote position, you generally need a background in healthcare administration, insurance, or customer service, often supported by relevant degrees or certifications. Familiarity with health plan management software, CRM systems, and telecommunication tools is typically required. Strong communication, self-motivation, and problem-solving abilities are essential soft skills for remote success. These skills and qualifications ensure efficient member support, regulatory compliance, and effective teamwork in a virtual environment.

What is the difference between Upmc Health Plan Remote vs Upmc Health Plan Customer Service Representative?

AspectUpmc Health Plan RemoteUpmc Health Plan Customer Service Representative
Work EnvironmentRemote, home-basedOffice or remote, depending on company policy
Required CredentialsHigh school diploma or equivalent; healthcare knowledge beneficialHigh school diploma or equivalent; excellent communication skills
Job FocusAdministrative support, member inquiries, plan detailsAssisting members with plan questions, claims, and coverage
Industry UsageCommon for remote healthcare rolesStandard customer service role within healthcare plans

Upmc Health Plan Remote positions typically involve working from home providing administrative and member support, requiring similar credentials as customer service roles. The main difference lies in the remote work setting versus in-office roles, with both roles focusing on healthcare plan assistance within the same industry.

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Upmc Health Plan Remote jobs near you
Infographic showing various Upmc Health Plan Remote job openings in the United States as of August 2026, with employment types broken down into 1% As Needed, 78% Full Time, 15% Part Time, and 6% Contract. Highlights an 92% Physical, 1% Hybrid, and 7% Remote job distribution, with an average salary of $150,761 per year, or $72.5 per hour.

Medical Director, Utilization Management

UPMC Health Plan

Pittsburgh, PA • Remote

Full-time

Re-posted 24 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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