Medical Director, Hematology/Oncology (Utilization Management & Clinical Strategy)
Full-Time Remote (Post-Onboarding) U.S. Licensed MD/DO
A nationally recognized healthcare organization is seeking an experienced Hematology/Oncology physician to serve in a high-impact Medical Director role focused on utilization management, oncology care determinations, and strategic program development. This position offers the opportunity to directly influence oncology treatment decisions, improve patient outcomes, and help shape an evolving in-house oncology management model.
Position Overview:
This physician leader will serve as a key clinical resource, providing expert oversight for oncology-related medical necessity reviews, prior authorizations, appeals, chronic disease management, and case-level determinations. The role combines clinical excellence with payer-side innovation, data-driven strategy, and collaboration across providers, hospitals, and health plan stakeholders.
Key Responsibilities:
- Serve as a clinical resource for staff by establishing criteria and protocols for medical treatment inquiries
- Review and render determinations on healthcare service and treatment requests, including prior authorizations and denials
- Conduct daily case reviews and participate in case-level discussions
- Provide clear, timely, and well-documented medical review determinations
- Offer clinical consultation and support to nursing and interdisciplinary teams
- Perform utilization review and case management support for complex oncology members
- Support chronic disease management through phone, messaging, and video platforms
- Conduct peer-to-peer discussions regarding clinical determinations as needed
- Serve as a medical liaison to physicians, hospitals, and insurance carriers
- Review appeals when not the original reviewer
- Analyze clinical and operational data to identify opportunities for improved interventions and best practices
- Help develop innovative strategies to enhance care quality while reducing external review dependency
Required Qualifications:
- Active, unrestricted MD or DO license in any U.S. state
- Hematology/Oncology background (Board Certification strongly preferred)
- 5+ years of clinical oncology experience
- Strong expertise in oncology case review, including chemotherapy, dosing, site-of-care, and treatment determinations
- Excellent written communication and peer-to-peer discussion skills
- Ability to thrive in a dynamic, evolving, and less structured environment
Preferred Qualifications:
- Prior Utilization Management experience
- Experience with InterQual, MCG, or clinical policy guidelines
- Previous health plan, payer-side, or physician advisor experience
- Medical Director leadership experience
- Background in building internal clinical programs or reducing external review spend
Schedule & Work Environment:
- Full-time, 40+ hours/week
- Monday Friday standard schedule
- Primarily remote after onboarding
- East Coast or Central hours preferred
- Weekly rounds participation expected
- Light travel: initial onboarding onsite + annual Ohio meeting
Compensation & Benefits Highlights:
- Approximate Base Salary: $275K
- 25% Performance Bonus
- Potential Sign-On Bonus Flexibility
- Remote Flexibility with minimal travel
- Strategic leadership visibility with senior clinical executives
- Opportunity to shape oncology strategy, virtual care innovation, and cost-of-care initiatives
Why This Role:
This is more than a traditional utilization review position it s an opportunity to directly shape oncology care delivery, influence policy, and help build a modernized internal oncology management program with significant executive exposure. Ideal for a Hem/Onc physician seeking strategic leadership beyond direct patient care.
