Medical Director

Job Description

Job Description

Description:

Our client, a leading health insurance organization, is seeking an accomplished Medical Director to join their executive team. This role offers the opportunity to make a significant impact on healthcare delivery, driving innovation and ensuring members receive high-quality, cost-effective care.

The Medical Director will provide clinical leadership and oversight across utilization management, medical policy, and quality improvement initiatives. The successful candidate will work closely with executive leadership, provider networks, and clinical teams to ensure compliance, enhance care standards, and improve member outcomes.

• Lead medical oversight for utilization management, case management, and clinical review processes.
  
  
• Evaluate complex medical cases for medical necessity and cost-effectiveness.
  
  
• Guide the development and implementation of medical policies and care standards.
  
  
• Ensure regulatory and accreditation compliance across programs.
  
  
• Collaborate with provider networks to strengthen relationships and maintain quality standards.
  
  
• Mentor and support clinical teams, promoting evidence-based best practices.
  
  
• Analyze clinical data to identify trends, risks, and opportunities for improvement.

• MD or DO degree with active, unrestricted medical license.  
• Board certification in a recognized specialty.  
• At least 5 years of clinical practice experience ; managed care or health insurance leadership strongly preferred.  
• Proven expertise in utilization management, medical policy, and quality improvement.  
• Strong leadership, communication, and decision-making skills.  
• Ability to influence stakeholders and collaborate across multidisciplinary teams.  

• Competitive salary aligned with executive leadership level.  
• Comprehensive health, retirement, and wellness benefits.  
• Professional growth and leadership development opportunities.