Regional Medical Director (Licensed Psychiatrist) *Hybrid- 28 hours per week; Report 2x per week to Media, PA*
Company: UPMC Southwestern PA
Location: Pittsburgh
Posted on: December 2, 2025
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Job Description:
Community Care Behavioral Health (CCBH) is seeking a qualified
individual to fulfill the role of Regional Medical Director in
Delaware County, PA. The Regional Medical Director is responsible
for assuring the quality and efficiency of the health care
delivered to Community Care members. This includes significant
responsibility for quality management and utilization management
and for assuring the adequacy of the provider network for the
clinical needs of Community Care members. The Medical Director also
participates in regional leadership policy decisions and strategic
planning. In addition, the Regional Medical Director is a resource
to participating providers in the provision of quality medical
care. The Regional Medical Director would join a highly educated
and motivated team of physician advisors at CCBHO who advocate well
for the recovery from mental health and substance use disorders for
nearly a million individuals across Pennsylvania. He or she would
have the opportunity to be involved in many new initiatives some of
which lend towards research and journal inclusion. This position is
Hybrid and will require an in-person presence in Media, PA at least
2 days per week. The selected candidate will have some flexibility
in their schedule availability (28/hrs weekly) Responsibilities: -
Reviews of complaints and grievances in accordance with Community
Care procedures, and to assure prompt response and action at all
stages of the complaint and grievance process. - Works with
Provider Relations to enhance the working relationship between
Community Care and the providers in its network. - Ensures the
quality of clinical care provided to Community Care members. -
Focus on quality and utilization from a regional perspective to
include UPMC Passavant and UPMC St. Margaret. - Assures the quality
of treatment and related services provided by Community Care
professional staff, through participation (directly or by designee)
in the ongoing quality management and audit processes. - Interfaces
with physician consultants and provides direction for the physician
consultants. Interfaces with the Physical Health MCO's through
Medical Director to Medical Director meetings and sits on
appropriate committees of the PH MCOs. - Reviews the medical
aspects of cost and utilization reports generated by Medical
Management Information System. - Acts as a liaison for Community
Care with community physicians, hospital staff, and other
professionals and agencies with regard to psychiatric services. -
Serve as advisor to quality departments from a regional
perspective. - Supports member satisfaction with the care
management process. - Implements quality management programs and
continuing education activities. - Develops and maintains effective
relationships with providers. - Serves as physician advisor for
UPMC Passavant McCandless and UPMC Passavant Cranberry and serves
as a backup for other business units - Advises the Regional
Director on the development and review of programs, positions, and
budgets having an impact on clinical services. - Effectively reduce
observation rates, length of stay, and readmission rates. - Work in
tandem with the UPMC Health Plan. - Acts as a physician reviewer
for cases referred by care management staff. - Focus on clinical
documentation improvement efforts thereby improving reimbursement
rates. - Interfaces with the Counties and DPW as indicated. - Works
with Quality Management in designing and evaluating protocols. -
Assures effective and appropriate utilization of the various levels
of care in the provider network. - Meets or exceeds NCQA, URAC or
other regulatory standards. - Participates in the appropriate
committees of physical health HMO's where applicable, such as a
pharmacy and therapeutics committee. - Works closely with the
medical directors of physical health HMO's to assure coordination
between physical health and behavioral health needs and services.
Qualifications: - Minimum 10 years clinical experience required. -
Doctor of Medicine or Doctor of Osteopathy from an accredited
school. - Unrestricted License in Pennsylvania. - Post residency
clinical experience. - Experience in Behavioral Health treatment
and program development. - Board certified in addiction medicine or
board certified in addiction psychiatry preferred. - At least 5
years of management experience preferred. - Experience in managed
care setting preferred. - Ability to implement medical policies,
and to enforce those policies through appropriate action. - Ability
to maintain effective professional liaison with all levels of
executive and medical staff, including professional and
institutional providers of care. - Ability to implement programs of
quality care analysis, peer review, and professional education.
Licensure, Certifications, and Clearances: - Doctor of Medicine or
Doctor of Osteopathy UPMC is an Equal Opportunity
Employer/Disability/Veteran
Keywords: UPMC Southwestern PA, Pittsburgh , Regional Medical Director (Licensed Psychiatrist) *Hybrid- 28 hours per week; Report 2x per week to Media, PA*, Healthcare , Pittsburgh, Pennsylvania
