Medical Director, Utilization Management — Hybrid

Quantum Health; United States; On-site; USD 210,000 - 260,000; Full time

Benefits offered by this job

Health insurance

401(k) with employer match

Generous PTO & holidays

Tuition reimbursement

Job summary

Quantum Health, the leader in healthcare navigation, seeks a Medical Director to join our Dublin, OH campus with hybrid flexibility. This physician will support clinical reviews, consultations, and utilization management, collaborating with our clinical team to improve member outcomes.

The role requires MD/DO with board certification and 5+ years of clinical practice, including 2+ years in physician review.

Qualifications

• MD or DO with board certification in primary specialty
• Minimum 5 years of progressively responsible clinical practice experience
• Minimum 2 years of physician clinical review experience
• Strong written and verbal communication skills with clear clinical documentation
• Collaborative, team-oriented mindset across disciplines
• Knowledge of the U.S. healthcare delivery system
• Familiarity with utilization management principles and evidence-based criteria
• Licensure to practice medicine and ability to obtain multistate licensure

Responsibilities

• Establishes criteria and protocols for standard medical treatment inquiries and renders determinations
• Performs utilization review and case management support on complex members
• Provides clinical and nurse consultations
• Supports chronic disease management via phone, messaging and video
• Acts as medical liaison to physicians, hospitals and insurance carriers
• Evaluates data and identifies improvement opportunities to enhance outcomes
• Handles appeals determinations when needed
• Maintains data privacy and adherence to ethics policies

Skills

Clinical leadership

Communication skills

Collaboration

Utilization management

Education

MD/DO

Tools

InterQual

Job description

Quantum Health, the leader in healthcare navigation, seeks a Medical Director to join our Dublin, OH campus with hybrid flexibility. This physician will support clinical reviews, consultations, and utilization management, collaborating with our clinical team to improve member outcomes.

The role requires MD/DO with board certification and 5+ years of clinical practice, including 2+ years in physician review.