Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.
About This Opportunity:
As the Part-Time Medical Director, you'll provide physician leadership for the organization's medical management and utilization review programs. You'll help ensure clinical decisions, medical policies, and review processes align with evidence-based medicine, regulatory requirements, and organizational standards.
In this role, you'll support quality improvement initiatives, complex medical necessity determinations, and the ongoing development of clinical programs while serving as a trusted clinical advisor to operational leadership and interdisciplinary teams.
Things You’ll Do Here:
- 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.
Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.
What You’ll Bring to the Team:
Required 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
Licensure Requirements- Active, unrestricted Texas medical license (full licensure, not an administrative license)
- Must hold active medical licenses in states that require physician licensure to perform utilization reviews. Current priorities include Maryland, New Hampshire, West Virginia, and Texas. Additional state licenses are preferred as business needs evolve.
A Plus If You Have- 5+ years of clinical experience
- Managed care or health insurance industry experience
Where You’ll Work: This is a fully remote position, and we’ll provide all the necessary equipment!
- Work Environment: You’ll need a quiet workspace that is free from distractions.
- Technology: Reliable internet connection—if you can use streaming services, you’re good to go!
- Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
- Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.
Why You'll Love Working Here
Valenz is proud to be recognized by Inc. 5000 as one of America’s fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. With this commitment, you’ll find an engaged culture – one that stands strong, vigorous, and healthy in all we do.
Benefits
- Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
- Spending account options: HSA, FSA, and DCFSA
- 401K with company match and immediate vesting
- Flexible working environment
- Generous Paid Time Off to include vacation, sick leave, and paid holidays
- Employee Assistance Program that includes professional counseling, referrals, and additional services
- Paid maternity and paternity leave
- Pet insurance
- Employee discounts on phone plans, car rentals and computers
- Community giveback opportunities, including paid time off for philanthropic endeavors
At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.
