Medical Director Utilization Management Oncology
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The Oncology Institute of Hope and Innovation Oncology Healthcare
California, Nevada, Arizona, Oregon, FloridaFull-TimeManager
Salary275,000 - 300,000 USD per year
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Job Details
- Experience
- Minimum of 5 years of clinical experience in oncology. 2+ years of Utilization Management experience
- Required Skills
- Data Analysis
Requirements
- Medical degree (MD or DO)
- Board Certification in Oncology
- Minimum of 5 years of clinical experience in oncology
- 2+ years of Utilization Management experience
- Expertise in reviewing clinical appropriateness of treatment plans
- Understanding of oncology-specific treatment protocols and reimbursement policies
- Excellent analytical skills and ability to evaluate complex clinical data
- Ability to work independently and make evidence-based decisions
- Excellent communication skills
Responsibilities
- Conduct medical reviews and make independent clinical decisions of hematology and oncology treatment plans
- Review and assess the appropriateness of ongoing cancer treatment plans
- Provide clinical guidance and recommendations that balance quality, outcomes, and cost-effectiveness
- Liaise with providers, insurance companies, and patients to clarify treatment options and coverage
- Evaluate clinical and utilization data to identify trends, variations in care, and opportunities for improvement
- Partner with clinical and operational teams to support value-based care
- Ensure compliance with organizational policies, regulatory standards, and payer requirements
- Participate in the development and improvement of utilization management protocols
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