Hybrid Medical Director, Utilization Management

Quantum Health, Inc.; Miami (FL); Hybrid; USD 180,000 - 260,000; Full time

Benefits offered by this job

Competitive base and incentive pay

Health, vision and dental coverage

401(k) with employer match

Paid time off and holidays

Tuition reimbursement and CE support

Leadership development opportunities

Best Place to Work culture

Job summary

Quantum Health, Inc. is seeking a Medical Director to lead medical review and clinical strategy in our virtual healthcare space, partnering with our clinical team to drive member outcomes.

This hybrid role based at our Dublin, OH campus focuses on utilization management, prior authorizations, and data-driven care decisions across our client organizations. The ideal candidate has MD/DO, board certification, 5+ years clinical practice and 2+ years review experience, with strong communication and

Qualifications

• MD or DO with board certification in primary specialty.
• 5+ years of progressively responsible clinical practice.
• 2+ years of physician clinical review experience.
• Strong written and verbal communication; clear clinical documentation.
• Collaborative, cross-disciplinary teamwork.
• Knowledge of the US healthcare delivery system.
• Familiarity with utilization management principles and evidence-based criteria (e.g., InterQual).
• Commitment to data protection and ethics.
• Unrestricted medical license with ability to obtain multistate licensure.

Responsibilities

• Serve as a key clinical resource for staff; establish criteria and protocols for standard medical treatment inquiries and renders determinations on requests for healthcare services.
• Review daily cases and conduct necessary case-level conversations including prior authorizations and denial decisions.
• Provide clear, documented medical review determinations within established timeframes.
• Provide clinical and nurse consultations.
• Identify opportunities to implement best practices and innovations to provide improved outcomes.
• Perform utilization review and case management support on complex members.
• Support members via phone, messaging, and video for chronic disease management.
• Engage in peer-to-peer discussions regarding determinations as necessary.
• Serve as a medical liaison to physicians, hospitals and insurers.
• Provide determinations on appeals.
• Utilize data resources to personalize care and evaluate outcomes.
• Evaluate and interpret data to identify improvements.
• All other duties as assigned.

Skills

Clinical leadership

Team collaboration

Communication skills

Utilization management

Education

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)

Job description

Quantum Health, Inc. is seeking a Medical Director to lead medical review and clinical strategy in our virtual healthcare space, partnering with our clinical team to drive member outcomes.

This hybrid role based at our Dublin, OH campus focuses on utilization management, prior authorizations, and data-driven care decisions across our client organizations. The ideal candidate has MD/DO, board certification, 5+ years clinical practice and 2+ years review experience, with strong communication and