Medical Director Utilization Management Oncology
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AI Summary
About The Oncology Institute (www.theoncologyinstitute.com):
Founded in 2007, The Oncology Institute (NASDAQ: TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI offers cutting-edge, evidence-based cancer care to a population of approximately 1.9 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With over 180 employed and affiliate clinicians and over 100 clinics and affiliate locations of care across five states and growing, TOI is changing oncology for the better.
Utilization Management Medical Director Oncology
Work Location: REMOTE (work from home)
California Nevada Arizona Oregon Florida
The Medical Director role provides clinical expertise in assessing the medical necessity, appropriateness, and efficiency of oncology care with a focus on direct utilization management for case review and clinical decision making.
In this collaborative role, you will work with physicians, clinical teams and operational leaders to support evidence-based high quality and cost-effective care delivery across the network. You will also contribute to cross-functional initiatives, data-driven insights, and oversight of utilization management policies to optimize patient outcomes.
Key Responsibilities:
- Conduct medical reviews and make independent clinical decisions of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices.
- Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices.
- Provide clinical guidance and recommendations that balance quality, outcomes, and cost-effectiveness.
- Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage.
- Evaluate clinical and utilization data to identify trends, variations in care, and opportunities for improvement
- Partner with clinical and operational teams to support value-based care.
- 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.
Qualifications:
- Medical degree (MD or DO)
- Board Certification in Oncology.
- Minimum of 5 years of clinical experience in oncology.
- 2+ years of Utilization Management experience
- Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans.
- Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies.
- Excellent analytical skills and the ability to evaluate complex clinical data.
- Ability to work independently and make evidence-based 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 set-up 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.
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