Medical Director, Vision

Health Network One

Medical Director providing oversight and strategic clinical leadership for vision related programs at Health Network One. Ensuring compliance with regulatory standards and enhancing client relationships.

Posted 5/13/2026full-timeRemote • Florida • 🇺🇸 United StatesLead💰 $275,000 - $325,000 per yearWebsite

About the role

Key responsibilities & impact

Provide clinical oversight and medical direction for vision related programs and services.
Ensure clinical policies, guidelines, and practices align with evidence based ophthalmology standards and applicable regulatory requirements.
Serve as the senior clinical authority for ophthalmology related questions, escalations, and complex case reviews.
Ensure compliance with GAAP, healthcare-specific regulations, and internal policies.
Perform and oversee utilization management reviews related to ophthalmology and vision services.
Conduct medical necessity determinations for prior authorization, concurrent, and retrospective reviews.
Review and adjudicate clinical appeals and denials, including peer to peer discussions with ordering and rendering providers.
Collaborate with operational and compliance teams to ensure utilization management activities meet contractual, regulatory, and accreditation standards.
Act as a client‑facing clinical leader and ophthalmology specialist for Health Network One’s vision service lines.
Participate in client meetings, presentations, and consultations to explain clinical programs, utilization management decisions, and outcomes.
Support client relationships, retention, and growth by providing credible, thoughtful clinical guidance.
Represent Health Network One with external stakeholders, including health plans, provider partners, and regulatory entities, as appropriate.
Partner with the CEO and executive leadership team to support strategic planning, clinical program design, and growth initiatives for vision services.
Provide clinical insight to inform organizational decision making, risk management, and performance improvement efforts.
Contribute to the development and refinement of clinical workflows, quality initiatives, and performance metrics aligned with organizational goals.
Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements.
Support quality management activities related to ophthalmology and vision services, including audits, reporting, and corrective action planning.
Promote a culture of clinical excellence, accountability, and patient centered decision making.

Requirements

What you’ll need

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with specialty training in Ophthalmology.
Active, unrestricted medical license in at least one U.S. state, with the ability to obtain additional licensure as needed.
Board certified or board eligible in Ophthalmology.
Demonstrated experience with utilization management, medical necessity review, appeals, and denials.
Strong executive level communication skills, including the ability to engage effectively with clients, providers, and senior leaders.
Experience in managed care, health plans, MSOs, or delegated specialty or vision services (preferred).
Prior experience in a physician executive or client facing clinical leadership role (preferred).
Familiarity with regulatory and accreditation standards related to utilization management and quality programs (preferred).

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account Health Network One Website LinkedIn All Job Openings 201 - 500 employees Founded 1999 ⚕️ Healthcare Insurance 🤝 B2B Healthcare Insurance
B2B Health Network One is a healthcare network management company that partners with health plans to manage specialty outpatient services (including outpatient therapy, routine and medical eye care, dermatology, and podiatry) under full-risk arrangements. The company operates nationally, covering over 7 million lives and contracting with tens of thousands of providers, and offers delegated services such as utilization management, credentialing, claims and network management. Health Network One emphasizes value‑based solutions, clinical quality, cost reduction for professional and facility spend, and holds NCQA accreditation and HITRUST CSF certification. Medical Director, Vision Job not on LinkedIn 🔥 13 minutes ago 🐊 Florida – Remote 💵 $275k - $325k / year ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
Provide clinical oversight and medical direction for vision related programs and services.
Ensure clinical policies, guidelines, and practices align with evidence based ophthalmology standards and applicable regulatory requirements.
Serve as the senior clinical authority for ophthalmology related questions, escalations, and complex case reviews.
Ensure compliance with GAAP, healthcare-specific regulations, and internal policies.
Perform and oversee utilization management reviews related to ophthalmology and vision services.
Conduct medical necessity determinations for prior authorization, concurrent, and retrospective reviews.
Review and adjudicate clinical appeals and denials, including peer to peer discussions with ordering and rendering providers.
Collaborate with operational and compliance teams to ensure utilization management activities meet contractual, regulatory, and accreditation standards.
Act as a client‑facing clinical leader and ophthalmology specialist for Health Network One’s vision service lines.
Participate in client meetings, presentations, and consultations to explain clinical programs, utilization management decisions, and outcomes.
Support client relationships, retention, and growth by providing credible, thoughtful clinical guidance.
Represent Health Network One with external stakeholders, including health plans, provider partners, and regulatory entities, as appropriate.
Partner with the CEO and executive leadership team to support strategic planning, clinical program design, and growth initiatives for vision services.
Provide clinical insight to inform organizational decision making, risk management, and performance improvement efforts.
Contribute to the development and refinement of clinical workflows, quality initiatives, and performance metrics aligned with organizational goals.
Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements.
Support quality management activities related to ophthalmology and vision services, including audits, reporting, and corrective action planning.
Promote a culture of clinical excellence, accountability, and patient centered decision making. 🎯 Requirements
Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with specialty training in Ophthalmology.
Active, unrestricted medical license in at least one U.S. state, with the ability to obtain additional licensure as needed.
Board certified or board eligible in Ophthalmology.
Demonstrated experience with utilization management, medical necessity review, appeals, and denials.
Strong executive level communication skills, including the ability to engage effectively with clients, providers, and senior leaders.
Experience in managed care, health plans, MSOs, or delegated specialty or vision services (preferred).
Prior experience in a physician executive or client facing clinical leadership role (preferred).
Familiarity with regulatory and accreditation standards related to utilization management and quality programs (preferred). Apply Now 📊 Check your resume score for this job Improve your chances of getting an interview by checking your resume score before you apply. Check Resume Score Similar Jobs Behavioral Health Medical Director – AI Policy & Governance 🔥 34 minutes ago CVS Health 10,000+ employees ⚕️ Healthcare Insurance 🛒 Retail 🧘 Wellness Website LinkedIn All Job Openings Behavioral Health Medical Director leading AI governance initiatives for CVS Health. Focusing on ethical AI use and quality assurance in behavioral health solutions. 🇺🇸 United States – Remote 💵 $174.1k - $374.9k / year ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director Associate Medical Director, Utilization Management 🔥 11 hours ago Oscar 51 - 200 🎯 Recruiter 🏢 Enterprise Website LinkedIn All Job Openings Associate Medical Director determining medical appropriateness of services in Utilization Management team at Oscar Health. Leading a team of physicians to ensure efficient management and quality adherence. 🇺🇸 United States – Remote 💵 $240.1k - $315.2k / year 💰 $140M Private Equity Round on 2020-12 ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director 🦅 H1B Visa Sponsor Field Medical Director, Radiology 🔥 12 hours ago Evolent 1001 - 5000 ⚕️ Healthcare Insurance ☁️ SaaS Website LinkedIn All Job Openings Field Medical Director specializing in Radiology at Evolent Health, a healthcare company improving outcomes. Engage in non-clinical utilization management and support healthcare providers. 🇺🇸 United States – Remote 💵 $95k - $100k / year ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director 🦅 H1B Visa Sponsor Primary Care Associate Medical Director 🕒 Yesterday The Cigna Group 10,000+ employees ⚕️ Healthcare Insurance 💊 Pharmaceuticals Website LinkedIn All Job Openings Virtual Primary Care Associate Medical Director managing and growing the service line at The Cigna Group. Responsible for clinical care delivery, quality, and engagement. 🇺🇸 United States – Remote 💵 $212.6k - $354.3k / year ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director Medical Director 🕒 Yesterday RVO Health 1001 - 5000 ⚕️ Healthcare Insurance 🧘 Wellness ☁️ SaaS Website LinkedIn All Job Openings Medical Director at RVO Health specializing in endocrinology and digital clinical products. Overseeing care delivery teams and driving growth initiatives through clinical research and innovations. 🇺🇸 United States – Remote 💵 $264k - $300k / year ⏰ Full Time 🔴 Lead 👨‍⚕️ Medical Director View More Medical Director Jobs 🌐 Worldwide Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com Search Search Jobs by country Search jobs by city Search jobs by job title Search entry-level jobs Search junior-level jobs Search senior-level jobs Search jobs by tech stack Search jobs by contract type Search remote internships Search remote part-time jobs Remote jobs Anywhere in the World Companies Hiring Anywhere in the World Companies Hiring Sales People Anywhere in the World Companies Hiring Software Engineers Anywhere in the World Resources Advice Tips for finding remote jobs Interview questions and answers Resume examples Cover letter examples Post a job Affiliates Privacy policy Terms of service Job board SEO course AI Apply Copilot OpenClaw job finder Jobs by Country Remote jobs anywhere in the world (Worldwide remote jobs) Remote jobs United States Remote jobs Australia Remote jobs Brazil Remote jobs Canada Remote jobs France Remote jobs Ireland Remote jobs Germany Remote jobs Netherlands Remote jobs Spain Remote jobs UK Popular Jobs Remote data analyst jobs Remote customer support jobs Remote executive assistant jobs Remote marketing jobs Remote product designer jobs Remote product manager jobs Remote project manager jobs Remote recruiter jobs Remote sales jobs Remote software engineer jobs Jobs by Type Remote full-time jobs Remote part-time jobs Remote contract jobs Remote internship jobs Remote entry-level jobs Remote jobs with no experience required Remote junior jobs (1-3 years of experience) Digital nomad jobs Remote jobs with no degree required Freelance remote jobs Temporary remote jobs Remote jobs hiring now Stay at home mom jobs

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Hard Skills & Tools

utilization managementmedical necessity reviewclinical appealsdenials managementclinical oversightevidence based ophthalmologyquality managementperformance improvementclinical workflowsaccreditation standards

Soft Skills

executive level communicationclient engagementclinical leadershipcollaborationstrategic planningclinical insightpatient centered decision makingaccountabilityrelationship managementpresentation skills

Certifications

Doctor of Medicine (MD)Doctor of Osteopathic Medicine (DO)board certified in Ophthalmologyactive medical license