Medical Director, Utilization Management (Hybrid)

Quantum Health, Inc.; Dublin, Northern (OH, KY); Hybrid; USD 180,000 - 260,000; Full time

Benefits offered by this job

Health, vision and dental

401(k) with employer match

PTO and paid holidays

Tuition reimbursement

Career development opportunities

Casual dress code and modern workplace

Wellness and on-site amenities

Job summary

Quantum Health, Inc. in Dublin, OH is hiring a Medical Director to lead clinical review in a virtual healthcare setting. The physician will collaborate with our clinical team to drive optimal outcomes for members, using evidence-based criteria and data‑driven decisions.

This hands‑on role emphasizes frontline engagement and operational excellence. The ideal candidate has an MD/DO with board certification and 5+ years of clinical practice, plus at least 2 years in clinical review within a

Qualifications

• MD or DO licensed in the US with board certification.
• At least five years of progressively responsible clinical experience.
• Minimum two years in physician clinical review, preferably with a health plan.
• Strong written and verbal communication; evidence-based documentation.
• Familiarity with utilization management and criteria like InterQual.

Responsibilities

• Serve as a key clinical resource for staff with standard treatment criteria.
• Review cases daily, including prior authorizations and denials.
• Provide clear, documented medical review determinations on requests.
• Offer clinical and nurse consultations to support care decisions.
• Identify best practices and opportunities for improvement.
• Support complex member utilization review and case management.
• Assist via phone, messaging, and video for chronic disease management.
• Engage in peer discussions regarding determinations when needed.
• Act as medical liaison to physicians, hospitals, and carriers.
• Determine appeals where initial decisions were not made.
• Leverage data tools to deliver personalized client care.
• Interpret data to identify improvement areas and interventions.

Skills

Clinical communication

Collaborative

InterQual knowledge

Utilization management

Healthcare system knowledge

Education

MD or DO

Board certification in primary specialty

5+ years clinical practice

2+ years physician clinical review

Job description

Quantum Health, Inc. in Dublin, OH is hiring a Medical Director to lead clinical review in a virtual healthcare setting. The physician will collaborate with our clinical team to drive optimal outcomes for members, using evidence-based criteria and data‑driven decisions.

This hands‑on role emphasizes frontline engagement and operational excellence. The ideal candidate has an MD/DO with board certification and 5+ years of clinical practice, plus at least 2 years in clinical review within a