Medical Director Utilization Management Oncology: Remote

The Oncology Institute of Hope and Innovation; Orlando, California, Miami, Cerritos (FL, MO, FL, CA); Remote; USD 275,000 - 325,000; Full time

Job summary

An established industry player is seeking a dedicated oncology expert to provide medical leadership in evaluating treatment plans. This remote role emphasizes collaboration and independent decision-making, ensuring cost-effective care while maintaining high patient outcomes. You'll be at the forefront of advancing oncology care, engaging with healthcare providers and patients, and contributing to the development of utilization management protocols. If you're passionate about improving cancer care and have a strong background in oncology, this opportunity could be your next great challenge.

Qualifications

• Minimum of 5 years of clinical experience in oncology.
• Proven expertise in Utilization Management.

Responsibilities

• Conduct medical reviews of oncology treatment plans for necessity and appropriateness.
• Make independent clinical decisions based on medical standards.

Skills

Analytical Skills

Communication Skills

Clinical Decision Making

Oncology Treatment Protocols

Utilization Management

Education

Medical degree (MD or DO)

Board Certification in Oncology

Job description

Founded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to a population of more than 1.7 million patients including clinical trials, stem cell transplants, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With 100+ employed clinicians and more than 700 teammates in 75+ clinic locations and growing. TOI is changing oncology for the better.

Work Location: REMOTE (work from home)

In this role, you will provide medical expertise and leadership in assessing the clinical necessity and appropriateness of oncology treatments, while ensuring cost-effective care without compromising patient outcomes. This is a highly collaborative, individual contributor position with no direct leadership responsibilities.

Key Responsibilities:

• Conduct medical reviews of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices.
• Evaluate clinical data and collaborate with healthcare providers to ensure optimal utilization of resources for oncology patients.
• Make independent clinical decisions on the appropriateness of treatments, imaging, and interventions based on established medical standards.
• Provide expert guidance and recommendations on appropriate oncology treatments while considering cost-effectiveness and patient care quality.
• Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage.
• Ensure compliance with organizational policies, regulatory standards, and payer requirements in all clinical decisions.
• Participate in the development and continuous improvement of utilization management protocols and criteria specific to oncology.
• Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices.

Qualifications:

• Medical degree (MD or DO)
• Board Certification in Oncology.
• Minimum of 5 years of clinical experience in oncology.
• Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans.
• Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies.
• Excellent analytical skills and the ability to evaluate complex clinical data.
• Ability to work independently and make evidence-based decisions in a collaborative, multidisciplinary setting.
• Excellent communication skills to engage effectively with healthcare providers, payers, and patients.

Ready to apply? Please complete the simple application and our team will reach out to you quickly.

Pay Transparency for salaried teammates:

$275,000 - $325,000 USD

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