Medical Director Utilization Management Oncology
New
Based in the United StatesFull-TimeDirector
Salary275,000 - 300,000 USD per year
Apply NowOpens the employer's application page
Job Details
- Experience
- Minimum of 5 years of clinical experience in oncology practice; At least 2+ years of experience in Utilization Management
- Required Skills
- Data Analysis
Requirements
- Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree with active, unrestricted licensure in the United States.
- Board Certification in Oncology (Hematology/Oncology preferred).
- Minimum of 5 years of clinical experience in oncology practice.
- At least 2+ years of experience in Utilization Management or clinical review of treatment appropriateness.
- Strong expertise in oncology treatment protocols, clinical guidelines, and reimbursement frameworks.
- Demonstrated ability to evaluate complex clinical cases and make independent, evidence-based decisions.
- Strong analytical skills with the ability to interpret clinical and utilization data effectively.
- Excellent communication skills for collaboration with physicians, payers, and multidisciplinary teams.
- Ability to work independently while contributing effectively in a team-based, cross-functional environment.
- Strong understanding of value-based care models and healthcare quality improvement initiatives.
Responsibilities
- Conduct independent medical reviews of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with evidence-based guidelines.
- Evaluate ongoing cancer treatment strategies to ensure consistency with clinical best practices and value-based care standards.
- Provide clinical recommendations that balance patient outcomes, quality of care, and cost-effectiveness considerations.
- Collaborate with physicians, payers, and patients to clarify treatment plans, coverage decisions, and clinical pathways.
- Analyze clinical and utilization data to identify trends, variation in care, and opportunities for improvement.
- Partner with clinical, operational, and administrative teams to support value-based care initiatives across the organization.
- Ensure compliance with internal policies, regulatory requirements, and payer guidelines in all clinical determinations.
- Contribute to the development and continuous improvement of utilization management protocols specific to oncology care.
- Participate in cross-functional initiatives focused on improving care delivery, efficiency, and patient outcomes.
- Support the optimization of oncology care pathways through evidence-based decision-making and clinical oversight.
View Full Description & ApplyYou'll be redirected to the employer's site
