Medical Director Utilization Management Oncology
| Company | The Oncology Institute of Hope and Innovation |
|---|---|
| Location | Norwalk, CA, USA, Miami, FL, USA |
| Salary | $275000 – $325000 |
| Type | Full-Time |
| Degrees | MD |
| Experience Level | Senior |
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
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No preferred qualifications provided.