Highmark’s Medical Review Committee resolves disputes between health service providers and Highmark, which may involve utilization and quality of care issues, as well as alleged violations of participating provider agreements and appeals regarding network terminations. The Committee also considers and reviews appeals for practitioners who have been denied privileges for providing imaging services.

The Committee is currently comprised of four doctors of medicine, one doctor of osteopathy, one doctor of chiropractic, one physical therapist, and two consumer representatives. The Medical Review Committee Selection Committee appoints the members to a two-year term. Members may be re-appointed.

Responsibilities

The Medical Review Committee generally meets four times a year via a Zoom video conference call. Members receive an honorarium from Highmark for meeting participation.

Considerable preparation time for the meetings may be required. Members are expected to attend all meetings and be prepared to participate in each case discussion.

Committee Member Requirements and How to Apply

All potential candidates must be a Pennsylvania licensed health care provider with one or more professional provider contracts with Highmark.

If you are interested in being considered for membership by the Medical Review Committee Selection Committee, please send a copy of your current resume or curriculum vitae, by Aug. 2, 2024, to: