Medical Director, Utilization Management (Hybrid)

Quantum Health, Inc.; Poland; Hybrid; PLN 819,000 - 1,266,000; Full time

Benefits offered by this job

Health, vision and dental

401(k) plan

PTO and holidays

Tuition reimbursement

Job summary

Quantum Health, Inc. seeks a Medical Director to lead clinical review and utilization management for its virtual healthcare space.

The role is based at our Dublin, OH campus with hybrid flexibility, requiring strong analytical skills, collaboration with the clinical team, and a passion for clear written and verbal communications. You will provide clinical and nurse consultations, drive best practices, and serve as a medical liaison to physicians, hospitals and carriers.

Qualifications

• MD or DO degree required.
• Board certification in primary specialty required.
• Minimum of five years of progressive clinical practice experience.
• Minimum of two years of physician clinical review experience, preferably in a commercial health plan or utilization management environment.
• Strong written and verbal communication skills with clear clinical documentation.
• Collaborative, team-oriented mindset across disciplines.

Responsibilities

• Serve as a key clinical resource for staff and establish criteria for medical treatment inquiries.
• Conduct daily case reviews, including prior authorizations and denial decisions per evidence-based criteria.
• Provide clear, concise documented medical review determinations and support requested reviews within established timelines.
• Offer clinical and nurse consultations to staff and members.
• Identify opportunities to implement best practices and innovations to improve outcomes.
• Perform utilization review and case management support on complex members.

Skills

Clinical leadership

Written communication

Team collaboration

Utilization management

Education

MD or DO

Job description

Quantum Health, Inc. seeks a Medical Director to lead clinical review and utilization management for its virtual healthcare space.

The role is based at our Dublin, OH campus with hybrid flexibility, requiring strong analytical skills, collaboration with the clinical team, and a passion for clear written and verbal communications. You will provide clinical and nurse consultations, drive best practices, and serve as a medical liaison to physicians, hospitals and carriers.