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Medical Director (Workers Compensation)
Philadelphia, PAJob Title: Medical Director
Job Summary
The Medical Director serves a clinical leadership role across all COMPANY (& subsidiaries) and is responsible for medical oversight of the physical medicine network and utilization review, telephonic triage, first notification of loss, bill review and case management services. This role ensures that injured worker care is medically appropriate, evidence-based, cost-effective, and compliant with jurisdictional guidelines.
Key Responsibilities
Clinical Oversight
Qualifications
Required:
Key Skills & Competencies
The Medical Director serves a clinical leadership role across all COMPANY (& subsidiaries) and is responsible for medical oversight of the physical medicine network and utilization review, telephonic triage, first notification of loss, bill review and case management services. This role ensures that injured worker care is medically appropriate, evidence-based, cost-effective, and compliant with jurisdictional guidelines.
Clinical Oversight
- Provide medical guidance on complex or high-cost workers’ compensation claims.
- Review treatment and make determinations of appropriateness based on medical evidence and industry guidelines
- Collaborate with internal and external stakeholders to ensure timely and appropriate care delivery.
- Lead or participate in utilization review and medical necessity determinations.
- Identify over- or under-utilization trends and support development of corrective strategies.
- Collaborate in the evaluation and credentialing of provider networks.
- Monitor provider performance and adherence to treatment guidelines.
- Lead provider engagement efforts to improve outcomes and reduce costs.
- Develop, update, and implement clinical guidelines and protocols.
- Train internal staff on medical topics relevant to workers’ compensation
- Stay current with clinical and regulatory changes affecting occupational medicine.
- Contribute to strategic initiatives across all departments.
- Partner with analytics and operations to measure and improve medical cost and outcome trends.
- Collaborate with sales and account management teams on client facing communication and meetings.
- Collaborate with marketing team and senior leadership on delivery of industry messaging.
- Performs other related duties as required or assigned.
Required:
- MD or DO from an accredited medical school.
- Board certification in a relevant specialty (e.g., Preventative, Medicine, Occupational Medicine, Physical Medicine & Rehabilitation, Family Medicine, Orthopedics).
- Unrestricted medical license
- Minimum 5 years of clinical experience, with at least 2 years in workers’ compensation, occupational health, or managed care.
- Experience with utilization review and evidence-based guidelines.
- Familiarity with state-specific workers’ comp regulations.
- Leadership or medical director experience in a payer or third-party administrator setting.
- Strong understanding of workers’ compensation systems, clinical best practices, and treatment guidelines.
- Ability to balance quality care with cost and compliance considerations.
- Excellent communication, collaboration, and decision-making skills.
- Proficiency with EMRs, claims platforms, and clinical decision support tools.