Medical Director Utilization Management Oncology: Remote

Utilization Management Medical Director Oncology

Work Location: REMOTE (work from home)

California Nevada Arizona Oregon Florida

In this role, you will provide medical expertise and leadership in assessing the clinical necessity and appropriateness of oncology treatments, while ensuring costeffective 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 valuebased clinical guidelines and evidencebased 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 costeffectiveness 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 evidencebased 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 oncologyspecific treatment protocols, guidelines, and reimbursement policies.
  • Excellent analytical skills and the ability to evaluate complex clinical data.
  • Ability to work independently and make evidencebased decisions in a collaborative, multidisciplinary setting.
  • Excellent communication skills to engage effectively with healthcare providers, payers, and patients.

  • If you’re interested in learning more, but not ready to apply, please reach out to our team to setup a call at your convenience. Physiciancareers@theoncologyinstitute.com

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

    The estimate displayed represents the typical wage range of candidates hired. Factors that may be used to determine your actual salary may include your specific skills, how many years of experience you have and comparison to other employees already in this role.

    Pay Transparency for salaried teammates

    $275,000—$300,000 USD