Medical Director, Virtual Care & Utilization Leadership

Quantum Health, Inc.; Poland; Hybrid; PLN 670,000 - 1,192,000; Full time

Benefits offered by this job

Health benefits

401(k) plan

Tuition reimbursement

Career development

Job summary

Quantum Health, Inc. seeks a Medical Director to lead clinical review and utilization management efforts at our Dublin, OH campus with hybrid flexibility.

The role focuses on data-driven medical decisions, collaboration with the clinical team, and ensuring optimal member care in a fast-paced healthcare navigation environment. The ideal candidate will have MD/DO credentials, board certification, and at least five years of clinical practice along with physician review experience in a health plan

Qualifications

• MD/DO with board certification in primary specialty.
• Minimum five years of clinical practice.
• Two+ years in physician clinical review, preferably in a health plan or UM environment.
• Strong written and verbal documentation and communication.
• Ability to collaborate across disciplines and use data to drive outcomes.
• In-depth knowledge of the U.S. healthcare delivery system.
• Maintain licensure across relevant jurisdictions.

Responsibilities

• Serve as a clinical resource for staff and establish treatment criteria.
• Review cases, approve prior authorizations and denials per criteria.
• Provide documented medical review determinations within deadlines.
• Offer clinical and nurse consultations.
• Identify opportunities to implement best practices and innovations.
• Perform utilization review and case management support.
• Act as medical liaison to physicians, hospitals and carriers.
• Handle appeals determinations and data-driven improvement.

Skills

Clinical review

Utilization management

Medical leadership

Written communication

Education

MD/DO

Tools

InterQual

Evidence-based criteria

Job description

Quantum Health, Inc. seeks a Medical Director to lead clinical review and utilization management efforts at our Dublin, OH campus with hybrid flexibility.

The role focuses on data-driven medical decisions, collaboration with the clinical team, and ensuring optimal member care in a fast-paced healthcare navigation environment. The ideal candidate will have MD/DO credentials, board certification, and at least five years of clinical practice along with physician review experience in a health plan