Medical Director (commercial health plan experience required)

Quantum Corporation; United States; Remote; USD 150,000 - 250,000; Full time

Job summary

An established industry player is seeking a Medical Director to lead clinical initiatives in healthcare navigation. This role requires a hands-on leader who will mentor staff, establish treatment protocols, and leverage data to improve clinical outcomes. The ideal candidate will have extensive clinical experience, strong communication skills, and a collaborative approach to problem-solving. Join a passionate team dedicated to simplifying healthcare for members, ensuring they receive the best care at an affordable cost. This is an exciting opportunity to make a significant impact in the healthcare sector while working in a supportive and innovative environment.

Benefits

Health, vision, and dental insurance

401(k) plan with employer match

Paid Time Off (PTO)

Tuition reimbursement

Complimentary fitness center

Paid sabbaticals

Casual dress code

Recognition as a Best Place to Work

Qualifications

• 5+ years of clinical practice experience in an inpatient environment.
• Board certification in primary specialty preferred.

Responsibilities

• Serve as a key clinical resource and mentor to staff.
• Establish criteria and protocols for medical treatment inquiries.

Skills

Clinical leadership

Analytical problem-solving

Communication skills

Collaboration

Medical review experience

Operational knowledge of healthcare delivery

Education

Doctor of Medicine (M.D.)

Doctor of Osteopathic Medicine (D.O.)

Tools

Microsoft Office

Teleconferencing tools (Teams, Zoom)

Job description

Medical Director (commercial health plan experience required)

Multistate Licensure: Quantum Health nurses must be willing and able to obtain and maintain nursing licensure in multiple states, as required by the business. All application and filing fees will be paid by Quantum Health.

Who we are

Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors.

We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.

About the role

The Medical Director is a primary clinical subject matter expert for the nation’s leader in healthcare navigation. This physician is a hands-on, roll-up-your-sleeves, solutions-oriented medical leader, focused on the front lines of healthcare delivery to guarantee the best possible clinical outcomes for our members. Reporting directly to the Chief Medical Officer, the Medical Director collaborates with nurses, clinical leaders, specialty clinicians, business leaders, providers, clients, and more, all to ensure the Quantum Health effect is realized by our members and clients.

What you’ll do

1. Serve as a key clinical resource and mentor to staff; provide regular nurse/clinician consultations and offer peer-to-peer overviews regarding determinations.
2. Serve as a designated medical liaison to physicians, hospitals, and insurance carriers.
3. Establish criteria and protocols for standard medical treatment inquiries and render determinations when a request for healthcare services is particularly complex/controversial or when there is little to no information or established criteria available.
4. Review individual cases and participate in case level conversations, including prior authorizations and denial decisions for cases that do not meet evidence-based criteria.
5. Provide documented medical review determinations and support requested reviews within established timeframes; provide determinations on appeals for cases where initial determinations were not made.
6. Utilize business intelligence and data to help the team provide more personalized care.
7. Interpret and leverage data to identify opportunities to innovate and improve clinical quality and service outcomes, with a focus on interventions.
8. Share clinical expertise in support of medical management programs through participation in clinical team activities.
9. Support Sales and Client Engagement/Retention activities as a designated clinical expert.
10. Conduct clinical education sessions as requested.
11. All other duties as assigned.

What you’ll bring

1. Education: Doctor of Medicine (M.D.) or Doctor of Osteopathic Medicine (D.O.) required.
2. Licensure / Certification: Current, unrestricted license to practice medicine in the State of Ohio required; Board certification in primary specialty (Internal Medicine, Emergency Medicine, Family Medicine, etc.) preferred.
3. Experience: 5+ years of related clinical practice, including in an inpatient environment.
4. Experience within the virtual healthcare space in a carrier or other administrative healthcare service provider; strong operational knowledge of the healthcare delivery system.
5. Physician clinical review/utilization management experience with knowledge of InterQual criteria.
6. Analytical, solutions-minded approaches to problem solving that combines and leverages scalable technology and personal, empathetic patient care.
7. Highly collaborative working style that engages stakeholders and SMEs at every level to produce positive results, directly contributing to project deliverables along the way.
8. Excellent written and verbal communication, comfortable interacting at all levels of the business with the ability to articulate complex clinical concepts to non-clinical audiences.
9. Strong administrative/technical skills; comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
10. Trustworthy and accountable behavior, capable of viewing and maintaining confidential information daily.

What’s in it for you

1. Compensation: Competitive base and incentive compensation.
2. Coverage: Health, vision, and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services, and more.
3. Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
4. Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
5. Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings, and leadership development.
6. Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.
7. Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services, and more!

What you should know

1. Internal Associates: Already a Healthcare Warrior? Apply internally through Jobvite.
2. Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background Check.
3. Diversity, Equity and Inclusion: Quantum Health welcomes everyone. We value our diverse team and suppliers, we’re committed to empowering our ERGs, and we’re proud to be an equal opportunity employer.
4. Tobacco-Free Campus: To further enable the health and wellbeing of our associates and community, Quantum Health maintains a tobacco-free environment. The use of all types of tobacco products is prohibited in all company facilities and on all company grounds.
5. Compensation Ranges: Compensation details published by job boards are estimates and not verified by Quantum Health. Details surrounding compensation will be disclosed throughout the interview process. Compensation offered is based on the candidate’s unique combination of experience and qualifications related to the position.
6. Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship.
7. Agencies: Quantum Health does not accept unsolicited resumes or outreach from third-parties. Absent a signed MSA and request/approval from Talent Acquisition to submit candidates for a specific requisition, we will not approve payment to any third party.

Reasonable Accommodation: Should you require reasonable accommodation(s) to participate in the application/interview/selection process, or in order to complete the essential duties of the position upon acceptance of a job offer, click here to submit a recruitment accommodation request.

Recruiting Scams: Unfortunately, scams targeting job seekers are common. To protect our candidates, we want to remind you that authorized representatives of Quantum Health will only contact you from an email address ending in @quantum-health.com. Quantum Health will never ask for personally identifiable information such as Date of Birth (DOB), Social Security Number (SSN), banking/direct/tax details, etc. via email or any other non-secure system, nor will we instruct you to make any purchases related to your employment. If you believe you’ve encountered a recruiting scam, report it to the Federal Trade Commission and your state’s Attorney General.