Medical Director, Clinical Specialty

Quantum Health

Medical Director at Quantum Health involved in clinical reviews and healthcare navigation services. Overseeing patient care decisions and collaborating with clinical teams for optimal outcomes.

Posted 4/24/2026full-timeDublin • Ohio • 🇺🇸 United StatesLeadWebsite

About the role

Key responsibilities & impact

Serves 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
Conducts daily review of individual cases and has necessary case level conversations as requested. This includes prior authorizations and denial decisions for cases that do not meet established evidence-based criteria
Provides clear and concise documented medical review determinations and support on requested reviews within the established time frames
Provides clinical and nurse consultations
Identifies opportunities to implement best practices approaches and introduce innovations to provide improved outcomes
Performs utilization review and case management support on complex members
Provides support over the phone, through messaging and video to support chronic disease management
Offers peer-to-peer discussions regarding determinations as necessary
Serves as a medical liaison to physicians, hospitals and insurance carriers
Provides determination on appeals for cases where they did not make the initial determination
Utilizes data resources and tools that help our team provide personalized care to our clients
Evaluates and interprets data. Identifies areas for improvement with a focus on interventions to improve client outcomes
All other duties as assigned.

Requirements

What you’ll need

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO)
Board certification in primary specialty required
Minimum of five (5) years of progressively responsible clinical practice experience
Minimum of two (2) years of physician clinical review experience, preferably within a commercial health plan or utilization management environment
Strong written and verbal communication skills, including clear clinical documentation
Collaborative, team-oriented mindset with the ability to work effectively across disciplines
Knowledge of the U.S. healthcare delivery system
Demonstrated knowledge of utilization management principles and evidence-based criteria (e.g., InterQual)
Commitment to protecting company and member data by adhering to organizational ethics, privacy, and security policies
Hold a current, valid, and unrestricted license to practice medicine recognized in the relevant jurisdiction(s)
Ability to obtain and maintain multistate licensure as required
Demonstrate familiarity with current, evidence-based clinical guidelines, standards of care, and relevant emerging or novel treatments.
Function under and provide oversight consistent with Medical Director responsibilities for utilization management activities

Benefits

Comp & perks

Health, vision and dental featuring our best-in-class healthcare navigation services
Life insurance
Legal and identity protection
Adoption assistance
EAP
Teladoc services
401(k) plan with up to 4% employer match and full vesting on day one
Paid Time Off (PTO)
7 paid holidays
Parental leave
Volunteer days
Paid sabbaticals
Tuition reimbursement up to $5,250 annually
Certification/continuing education reimbursement
Discounted higher education partnerships
Paid trainings and leadership development
Recognition as a Best Place to Work for 15+ years
Dedication to diversity, philanthropy and sustainability
Modern workplace with a casual dress code
Open floor plans
Full-service dining
Free snacks and drinks
Complimentary 24/7 fitness center with group classes
Outdoor walking paths
Game room
Notary and dry-cleaning services

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical reviewutilization managementevidence-based criteriadata evaluationchronic disease managementcase managementmedical documentationpeer-to-peer discussionsbest practices implementationinnovations in healthcare

Soft Skills

strong written communicationstrong verbal communicationcollaborative mindsetteam-orientedability to work across disciplinesclear clinical documentationcommitment to ethicsprivacy adherencesecurity policies adherenceinterpersonal skills

Certifications

Doctor of Medicine (MD)Doctor of Osteopathic Medicine (DO)board certification in primary specialtycurrent medical licensemultistate licensure