Medical Director Utilization Management Oncology: Remote

Medical degree (MD or DO) Board Certification in Oncology. Minimum of 5 years of clinical experience in oncology. Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans. Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies. Excellent analytical skills and the ability to evaluate complex clinical data. Ability to work independently and make evidence-based decisions in a collaborative, multidisciplinary setting. Excellent communication skills to engage effectively with healthcare providers, payers, and patients.

Conduct medical reviews of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices. Evaluate clinical data and collaborate with healthcare providers to ensure optimal utilization of resources for oncology patients. Make independent clinical decisions on the appropriateness of treatments, imaging, and interventions based on established medical standards. Provide expert guidance and recommendations on appropriate oncology treatments while considering cost-effectiveness and patient care quality. Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage. Ensure compliance with organizational policies, regulatory standards, and payer requirements in all clinical decisions. Participate in the development and continuous improvement of utilization management protocols and criteria specific to oncology. Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices.