Senior Medical Director
Abbott
Medical Director – Medical Management, Client Partnerships
Quantum Health
full-time
Posted on:
Location Type: Remote
Location: Remote • 🇺🇸 United States
Visit company websiteJob Level
Lead
About the role
- 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.
- Translate complex 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.
- 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 point of escalation for complex client inquiries or concerns.
- Ensure that all 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.
- 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 within the established time frames.
- Provide clinical and nurse consultations.
- Identify opportunities to implement best practices approaches and introduce innovations to provide improved outcomes.
- Perform utilization review and case management support on complex 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 make the initial determination.
Requirements
- Current, unrestricted license to practice medicine required and the ability to become multistate licensed.
- Board certification in primary specialty required.
- Five years of progressively related 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 mindset.
- Knowledge of health care delivery system.
- Knowledge of utilization management and InterQual criteria.
- Proficiency required in understanding market trends, insights, clinical models, and managed care systems.
Benefits
- Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.
- 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, and more.
- 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, and people-first values that drive every decision.
- A 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 and more!
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard skills
clinical reviewutilization managementcase managementpopulation health data analysismedical claims interpretationROI analysisevidence-based guidelinesclinical programminghealthcare service determinationclinical consultation
Soft skills
communication skillscollaborative mindsetclient relationship managementpresentation skillsproblem-solvingstrategic thinkingeducational skillsconsultative approachteam orientationclient advocacy
Certifications
unrestricted medical licenseboard certification in primary specialty
