Remote Medical Director, Utilization & Policy Innovation

Valenzhealth; United States; On-site; USD 165,312 - 247,968; Part time

Benefits offered by this job

Medical, Dental, Vision insurance

Health Savings Account (HSA)

401K with employer match

Flexible working environment

Paid time off

Employee Assistance Program

Paid maternity/paternity leave

Pet insurance

Discounts on devices and telecom

Community giveback opportunities

Job summary

Valenz Health is seeking a Part-Time Medical Director to provide physician leadership for medical management and utilization review programs. You will ensure decisions and policies align with evidence-based medicine and regulatory requirements while advising operational leadership.

You'll support quality initiatives, complex medical necessity determinations, and the development of clinical programs, serving as a trusted clinical advisor to interdisciplinary teams while working remotely across

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 CMS, URAC, and state-specific requirements.
• Strong interpersonal, organizational, and analytical skills.

Responsibilities

• Provide physician leadership in developing, implementing, and evaluating evidence-based clinical guidelines, medical policies, and utilization management protocols.
• Ensure clinical programs and medical management processes align with current standards of care, accreditation and regulations.
• Serve as the clinical authority for complex utilization review cases and provide medical expertise and final determinations as appropriate.
• Promote consistency and defensibility in medical decision-making across review activities.
• Collaborate with Clinical Operations, Compliance, Legal, and leadership to develop and update policies and guidelines.
• Monitor changes in clinical practice guidelines and regulations, recommending policy updates.
• Provide physician oversight for quality initiatives by reviewing outcomes and reporting to Quality Committee.
• Participate in audits, regulatory reviews, and quality improvement initiatives.

Skills

Interpersonal skills

Analytical skills

Organizational skills

Regulatory knowledge

Education

MD or DO with active license

Board certification

Job description

Valenz Health is seeking a Part-Time Medical Director to provide physician leadership for medical management and utilization review programs. You will ensure decisions and policies align with evidence-based medicine and regulatory requirements while advising operational leadership.

You'll support quality initiatives, complex medical necessity determinations, and the development of clinical programs, serving as a trusted clinical advisor to interdisciplinary teams while working remotely across