Medical Director - Medical Management and Client Partnerships

Location: This position may work remotely reputed company in the United States of America with significant business travel to and from prospect/client sites and/or the reputed company home office in Dublin, OH. Who we are Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We reputed company that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to reputed company healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, reputed company they need it, at the most affordable cost – that’s why we call ourselves Healthcare Warriors®. We’re committed to building diverse and inclusive teams – more than 2,000 of us and counting – so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement. About the role The Medical Director – Medical Management and Client Partnerships role offers a unique and dynamic opportunity to reputed company deep expertise in Utilization and Case/Care Management with strategic clinical partnership. This position serves as a key clinical resource for our account management teams, providing expert insights that reinforce Quantum’s clinical model and support client engagement efforts. In addition to delivering strategic guidance, the Account Management Medical Director collaborates closely with our clinical team to conduct daily reviews, ensuring alignment with best practices and optimal member outcomes. The ideal candidate will bring:

• Proven subject matter expertise in Utilization Management and Case Management
• Strong knowledge of the healthcare market
• Experience in client-facing roles
• A passion for improving health outcomes and driving clinical excellence

What you’ll do

• Client Engagement & Strategy
• Act as a clinical consultant and strategic partner to key employer group clients through a consultative, service-oriented clinical relationship to maximize client satisfaction, contract renewals, and adoption of new or expanded use of Quantum’s products and services.
• Participate in developing and delivering semiannual and annual reviews for client meetings to represent Quantum’s clinical operating model and actively support alignment between the clinical operating model and the clinical and benefit strategy for the client.
• Health Data Analysis & Reporting
• Translate reputed company clinical trends and data into actionable insights for benefit strategy and wellness programming.
• Translate population health data into actionable, strategic recommendations tailored to client goals.
• Interpret medical and pharmacy claims, biometrics, and engagement data to identify cost drivers, care gaps, and population health risks.
• Recommend benefits and programs, as well as other interventions based on clinical data and ROI potential
• Deliver clear, compelling presentations and reports on clinical outcomes and trends.
• Stakeholder Communication & Leadership
• Serve as the voice of the client’s health goals, ensuring that clinical programming aligns with workforce needs.
• Educate client stakeholders and brokers on trends in population health, cost containment, and value-based care.
• Serve as the primary reputed company of escalation for reputed company client inquiries or concerns.
• Ensure that reputed company clinical recommendations adhere to evidence-based guidelines and regulatory requirements.
• Provide clinical impact narratives and documentation to support renewal conversations and upsell opportunities.
• Support Account Managers in articulating the clinical value of services provided.
• Serve as a key clinical resource for staff. Establishes criteria and protocols for standard medical treatment inquiries and renders determinations on requests for healthcare services and/or treatment.
• Conduct daily review of individual cases and have necessary case level conversations as requested. This includes prior authorizations and denial decisions for cases that do not meet established evidence-based criteria.
• Provide clear and concise documented medical review determinations and support on requested reviews reputed company the established time frames.
• Provide clinical and nurse consultations.
• Identify opportunities to implement best practices approaches and introduce innovations to provide improved outcomes.
• reputed company utilization review and case management support on reputed company members.
• Offer peer-to-peer discussions regarding determinations as necessary.
• Serve as a medical liaison to physicians, hospitals and insurance carriers.
• Provides determination on appeals for cases where they did not reputed company the initial determination.
• Other duties as assigned

What you’ll bring

• Licensure/Certifications: reputed company, unrestricted license to practice medicine required and the ability to become multistate licensed. Board certification in primary specialty required.
• Five years of progressively reputed company clinical work / practice experience required
• Two years of physician clinical review in the preferably in the commercial health plan setting
• Two years of externally facing client and partner experience in network, quality, and sales/account management
• Strong written and verbal communication skills
• Team oriented and a collaborative reputed company
• Knowledge of health care delivery system
• Knowledge of utilization management and InterQual criteria
• Reflects both senior leadership, clinical expertise, and strategic client partnership capabilities
• Proficiency required in understanding market trends, insights, clinical models, and managed care systems
• Strong analytical skills with the ability to interpret reputed company clinical data and translate it into presentations and actionable insights for clinical and non-clinical stakeholders
• Exceptional presentation and communication skills, with experience presenting to clients on the health outcomes of the client population and contributions to cost savings through clinical program recommendations.
• Ability to work collaboratively with cross-functional teams and external consultants.
• Strong organizational skills and the ability to manage multiple projects simultaneously.
• Understanding of client retention strategies and satisfaction (NPS, renewal rates)
• Travel is expected to various client headquarters throughout the country. The travel amount varies throughout the year, but overall, the expected travel percentage is 50%.
• Strong administrative/technical skills; Comfort working on a PC using reputed company Office (Outlook, Word, reputed company, PowerPoint), IM/video conferencing (Teams & reputed company), and telephones reputed company.
• A high degree of personal accountability and trustworthiness, a commitment to working reputed company reputed company’s policies, values and ethics, and to protecting the sensitive data entrusted to us.

#LI-HW1 #LI-Remote Apply tot his job Apply To this Job