Medical Director Utilization Management Oncology

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Medical Director, Utilization Management Oncology based in the United States. This role plays a critical part in advancing value-based cancer care by ensuring that oncology treatments are clinically appropriate, evidence-based, and aligned with best practices. You will serve as a key clinical decision-maker within utilization management, reviewing complex hematology and oncology cases and guiding treatment determinations that balance quality of care, patient outcomes, and cost efficiency. The position requires close collaboration with physicians, clinical teams, and operational leaders to support consistent, high-quality care delivery across a large, multi-state network. You will also contribute to shaping utilization management policies and protocols that directly influence how cancer care is delivered at scale. This is a highly impactful leadership role combining clinical expertise, data-driven decision-making, and system-level influence in a mission-driven healthcare environment. \n Accountabilities: Conduct independent medical reviews of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with evidence-based guidelines Evaluate ongoing cancer treatment strategies to ensure consistency with clinical best practices and value-based care standards Provide clinical recommendations that balance patient outcomes, quality of care, and cost-effectiveness considerations Collaborate with physicians, payers, and patients to clarify treatment plans, coverage decisions, and clinical pathways Analyze clinical and utilization data to identify trends, variation in care, and opportunities for improvement Partner with clinical, operational, and administrative teams to support value-based care initiatives across the organization Ensure compliance with internal policies, regulatory requirements, and payer guidelines in all clinical determinations Contribute to the development and continuous improvement of utilization management protocols specific to oncology care Participate in cross-functional initiatives focused on improving care delivery, efficiency, and patient outcomes Support the optimization of oncology care pathways through evidence-based decision-making and clinical oversight Requirements: Medical Doctor (MD) or Doctor of Osteopathic Medicine (DO) degree with active, unrestricted licensure in the United States Board Certification in Oncology (Hematology/Oncology preferred) Minimum of 5 years of clinical experience in oncology practice At least 2+ years of experience in Utilization Management or clinical review of treatment appropriateness Strong expertise in oncology treatment protocols, clinical guidelines, and reimbursement frameworks Demonstrated ability to evaluate complex clinical cases and make independent, evidence-based decisions Strong analytical skills with the ability to interpret clinical and utilization data effectively Excellent communication skills for collaboration with physicians, payers, and multidisciplinary teams Ability to work independently while contributing effectively in a team-based, cross-functional environment Strong understanding of value-based care models and healthcare quality improvement initiatives Benefits: Competitive annual salary: $275,000 – $300,000 USD Remote work flexibility within eligible U.S. states Comprehensive medical, dental, and vision insurance Mission-driven environment focused on advancing value-based cancer care Opportunity to influence oncology care delivery across a large, multi-state clinical network Collaborative, multidisciplinary clinical culture Professional impact through shaping utilization management policies and protocols Stable leadership role within a rapidly growing oncology organization Supportive environment focused on clinical excellence and continuous improvement. \n How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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