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Senior Managing Medical Director

41 minutes ago
United States
Full-time
Lead
Operations Manager
Operations
Apply Now
Quantum Health

Quantum Health

Quantum Health is an award-winning care coordination and consumer navigation company based in Columbus, Ohio. Since 1999, they have been providing a uniquely powerful solution to drive healthcare benefits performance, focusing on cost savings, utilizat...

Professional Services
1K-5K
Founded 1999
View All Jobs 14

Description

  • Lead, manage, coach, and develop the Medical Director team, including hiring, onboarding, scheduling, performance evaluation, and competency development.
  • Monitor physician productivity, decision quality, turnaround times, documentation accuracy, and inter-rater reliability.
  • Oversee complex utilization management activities, including high-cost claimant reviews, prior authorization, concurrent reviews, denials, appeals, and peer-to-peer discussions.
  • Provide clinical consultation to nurses, care coordinators, and interdisciplinary teams supporting complex and high-risk members.
  • Evaluate clinical and utilization data to identify care gaps, trends, risks, and process improvement opportunities.
  • Serve as a senior escalation resource and subject matter expert for complex clinical reviews and utilization management operations.
  • Support client meetings, sales and business development, clinical product development, audits, accreditation readiness, and quality improvement initiatives.
  • Collaborate with Quality, Operations, Product, Human Resources, and executive leadership on clinical governance and strategic projects.
  • Build a physician culture focused on quality, service excellence, operational performance, and member outcomes.

Requirements

  • MD or DO with current, valid, unrestricted medical licensure and ability to obtain and maintain multistate licensure as needed.
  • Board certification in a primary specialty.
  • At least 8 years of progressively responsible clinical practice experience; 3 years of formal leadership experience preferred.
  • 3–5 years of physician clinical review experience, preferably in a commercial health plan or utilization management setting.
  • Strong knowledge of utilization management principles, InterQual, MCG, evidence-based criteria, and applicable regulatory requirements.
  • Knowledge of the U.S. healthcare delivery system, standards of care, clinical guidelines, and emerging treatments.
  • Experience supporting regulatory, accreditation, client, or delegated-entity audits.
  • Experience using clinical and operational data to manage physician quality, productivity, timeliness, and decision consistency.
  • Excellent written, verbal, executive-facing, client-facing, and clinical documentation skills.
  • Remote role requiring approximately 25% travel to headquarters; candidates must be permanently authorized to work in the United States without sponsorship.

Benefits

  • Competitive base and incentive compensation.
  • Health, vision, dental, life insurance, legal and identity protection, adoption assistance, EAP, and Teladoc services.
  • 401(k) plan with up to 4% employer match and full vesting on day one.
  • Paid time off, seven paid holidays, parental leave, volunteer days, and paid sabbaticals.
  • Up to $5,250 annually in tuition reimbursement plus certification, continuing education, training, and leadership development support.
  • Complimentary 24/7 fitness center, group classes, walking paths, snacks and drinks, and other workplace amenities.
  • Inclusive, people-first culture with diversity, philanthropy, and sustainability initiatives.

Interested in this position?

Apply directly on the company website

Apply Now

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