Hybrid Medical Director – Utilization & Policy Leadership

Cambia Health; Boise (ID); Hybrid; USD 207,000 - 337,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Paid time off

Work-from-home options

Job summary

Cambia Health is seeking an Associate Medical Director or Medical Director to lead utilization management and provide clinical leadership across our physician review teams. The role requires MD/DO, active licenses in at least one state and in four-state area, and board certification.

The position involves optimizing member care, collaborating with clinical staff, and participating in credentialing and policy development. A dynamic, mission-driven environment offers growth and impact.

Qualifications

• MD or DO with active, unrestricted U.S. license in OR/WA/ID/UT and four-state residency.
• Board Certification required.
• Minimum 3 years clinical experience or equivalent combination of education and experience.

Responsibilities

• Provide clinical leadership for utilization management and ensure safe, cost-efficient care.
• Conduct peer clinical reviews for medical necessity on authorization requests.
• Collaborate with CM staff on case management and medical policy reviews.
• Discuss review determinations with providers and participate in peer-to-peer conversations.
• Coordinate between internal programs and external care providers to improve quality and cost.

Skills

Clinical leadership

Utilization management

Peer review

Data analysis

Communication

Education

MD or DO degree

Job description

Cambia Health is seeking an Associate Medical Director or Medical Director to lead utilization management and provide clinical leadership across our physician review teams. The role requires MD/DO, active licenses in at least one state and in four-state area, and board certification.

The position involves optimizing member care, collaborating with clinical staff, and participating in credentialing and policy development. A dynamic, mission-driven environment offers growth and impact.