Senior Medical Director, Utilization & Quality (Remote)

Quantum Health, Inc.; Minneapolis (MN); Hybrid; USD 250,000 - 350,000; Full time

Benefits offered by this job

Health, vision and dental coverage

401(k) match

PTO and holidays

Tuition reimbursement

Job summary

Quantum Health, Inc. is seeking a Senior Management Medical Director to provide clinical and operational leadership for utilization management programs.

This role oversees the Medical Director team, drives high-level clinical reviews, and partners with executive leadership to grow client services and ensure quality care. The position emphasizes strategic collaboration, physician guidance, regulatory compliance, and development of clinical products while maintaining a patient-centered,

Qualifications

• Hold a current, valid, unrestricted MD/DO license.
• Board certification in primary specialty required.
• Minimum eight years of clinical practice with leadership experience preferred.
• Minimum three to five years of physician clinical review experience.
• Remote with travel – 25% of time; strong in UM principles.

Responsibilities

• Lead Medical Director team with direct guidance and hiring decisions.
• Oversee onboarding, orientation, and competency development for Medical Directors.
• Provide clinical leadership for utilization management and enterprise quality initiatives.
• Render UR determinations and appeal decisions based on evidence-based criteria.
• Support client engagement, audits, and regulatory compliance.
• Drive process improvements and performance metrics across UM operations.
• Collaborate across Quality, Operations, Product, and Executive teams.
• Lead inter-rater reliability activities and physician quality reviews.

Skills

UM principles

Regulatory audits

Executive communication

Team leadership

Cross-functional collaboration

Remote with Travel 25%

Education

MD or DO

Board certification

Medical license

Multistate licensure

Tools

InterQual

MCG

Job description

Quantum Health, Inc. is seeking a Senior Management Medical Director to provide clinical and operational leadership for utilization management programs.

This role oversees the Medical Director team, drives high-level clinical reviews, and partners with executive leadership to grow client services and ensure quality care. The position emphasizes strategic collaboration, physician guidance, regulatory compliance, and development of clinical products while maintaining a patient-centered,