Medical Director Utilization Management Oncology: Remote

Founded in 2007, The Oncology Institute of Hope and Innovation (TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI is dedicated to offering cutting edge, evidence-based cancer care to a population of more than 1.7 million patients including clinical trials, stem cell transplants, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With 100+ employed clinicians and more than 700 teammates in 75+ clinic locations 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

In this role, you will provide medical expertise and leadership in assessing the clinical necessity and appropriateness of oncology treatments, while ensuring cost-effective 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 value-based clinical guidelines and evidence-based 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 cost-effectiveness 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 evidence-based 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 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. [email protected]

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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.

Originally posted on Himalayas