Remote Medical Director, Utilization & Policy

Vālenz Health®; Phoenix (AZ); On-site; USD 60,000 - 120,000; Part time

Benefits offered by this job

Fully remote

Healthcare coverage

401(k) with match

Paid time off

Equipment provided

HIPAA-compliant tools

Job summary

Valenz Health is seeking a Part-Time Medical Director to provide physician leadership for medical management and utilization review programs. You will align clinical decisions and policies with evidence-based medicine, regulations, and organizational standards in a fully remote role based in the United States.

You will collaborate with operational leadership to develop standards, oversee medical necessity determinations, and drive quality improvement across programs, fostering high-quality,

Qualifications

• MD or DO degree with an active, unrestricted medical license.
• Board certification in a recognized specialty.
• Experience with utilization management, medical policy development, and clinical program oversight.
• Familiarity with applicable regulations (e.g., CMS, URAC, and state-specific requirements).
• Strong interpersonal, organizational, and analytical skills.

Responsibilities

• Provide physician leadership in the development, implementation, and ongoing evaluation of evidence-based clinical guidelines, medical policies, and utilization management protocols to support high-quality, clinically appropriate decision-making.
• Ensure clinical programs, utilization review activities, and medical management processes align with current standards of care, evidence-based medicine, accreditation requirements, and applicable federal and state regulations.
• Serve as the clinical authority for complex, high-risk, or escalated utilization review cases by providing medical expertise, benefit interpretation, and final medical necessity determinations as appropriate.
• Promote consistency, accuracy, and defensibility in medical decision-making by applying sound clinical judgment and established medical necessity criteria across all review activities.
• Collaborate with Clinical Operations, Compliance, Legal, and executive leadership to develop, review, and revise clinical and administrative policies, medical necessity guidelines, and benefit interpretation criteria.
• Monitor changes in clinical practice guidelines, healthcare regulations, payer requirements, and industry best practices, recommending updates to organizational policies and review processes as necessary.
• Provide physician oversight for quality and performance initiatives by reviewing medical management outcomes, analyzing quality metrics, and participating in quarterly Quality Committee meetings and reporting.
• Participate in internal audits, accreditation activities, regulatory reviews, and quality improvement initiatives to ensure compliance with organizational standards and continuous operational excellence.
• Partner with operational leadership to ensure clinical standards are effectively integrated into utilization review workflows, promoting efficient, evidence-based, and member-focused medical management.
• Provide clinical consultation and recommendations regarding post-service medical necessity determinations, appeals, and other medically complex cases requiring physician review.
• Serve as a trusted clinical resource and advisor to physicians, nurses, utilization review staff, and cross-functional business partners by providing education, guidance, and consultation on medical policy and clinical best practices.
• Participate in interdisciplinary committees, physician advisory groups, and organizational meetings to provide clinical insight and support strategic initiatives.
• Foster collaborative relationships with internal and external stakeholders to promote quality outcomes, regulatory compliance, and continuous improvement across medical management programs.
• Perform other duties as assigned.

Skills

MD/DO

Board Certification

Utilization management

Clinical policy

Analytical skills

Education

MD/DO degree

Job description

Valenz Health is seeking a Part-Time Medical Director to provide physician leadership for medical management and utilization review programs. You will align clinical decisions and policies with evidence-based medicine, regulations, and organizational standards in a fully remote role based in the United States.

You will collaborate with operational leadership to develop standards, oversee medical necessity determinations, and drive quality improvement across programs, fostering high-quality,