Medical Director Utilization Management Oncology

Medical Director Utilization Management Oncology

Requirements

• 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.

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.

Preferred Qualifications

No preferred qualifications provided.