Medical Director – Part Time

Vālenz® Health

Part-Time Medical Director providing physician leadership in medical management and utilization review programs. Joining Vālenz Health to support quality improvement and clinical program development initiatives.

Posted 7/23/2026part-timeRemote • Maryland, New Hampshire, Texas, Virginia, West Virginia • 🇺🇸 United StatesLeadWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in clinical guideline development, utilization management, and medical policy oversight, ensuring compliance with regulations and high-quality decision-making. Provides clinical consultation and leadership in complex medical necessity determinations and quality improvement initiatives.

Highest-signal resume keywords

MD Or DO DegreeBoard Certification In A Recognized SpecialtyUtilization Management ExperienceMedical Policy DevelopmentActive Unrestricted Medical License

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Clinical Guideline DevelopmentUtilization ReviewMedical Necessity DeterminationQuality Metrics AnalysisRegulatory Compliance

Soft Skills

Interpersonal SkillsOrganizational SkillsAnalytical Skills

Certifications & Qualifications

Active Medical License In TexasAdditional State Licenses Preferred

Industry Keywords

Evidence-Based MedicineAccreditation RequirementsCMS RegulationsURAC StandardsClinical Operations

About the role

Key responsibilities & impact

Provide physician leadership in the development, implementation, and ongoing evaluation of evidence-based clinical guidelines, medical policies, and utilization management protocols to support high-quality, clinically appropriate decision-making.
Ensure clinical programs, utilization review activities, and medical management processes align with current standards of care, evidence-based medicine, accreditation requirements, and applicable federal and state regulations.
Serve as the clinical authority for complex, high-risk, or escalated utilization review cases by providing medical expertise, benefit interpretation, and final medical necessity determinations as appropriate.
Promote consistency, accuracy, and defensibility in medical decision-making by applying sound clinical judgment and established medical necessity criteria across all review activities.
Collaborate with Clinical Operations, Compliance, Legal, and executive leadership to develop, review, and revise clinical and administrative policies, medical necessity guidelines, and benefit interpretation criteria.
Monitor changes in clinical practice guidelines, healthcare regulations, payer requirements, and industry best practices, recommending updates to organizational policies and review processes as necessary.
Provide physician oversight for quality and performance initiatives by reviewing medical management outcomes, analyzing quality metrics, and participating in quarterly Quality Committee meetings and reporting.
Participate in internal audits, accreditation activities, regulatory reviews, and quality improvement initiatives to ensure compliance with organizational standards and continuous operational excellence.
Partner with operational leadership to ensure clinical standards are effectively integrated into utilization review workflows, promoting efficient, evidence-based, and member-focused medical management.
Provide clinical consultation and recommendations regarding post-service medical necessity determinations, appeals, and other medically complex cases requiring physician review.
Serve as a trusted clinical resource and advisor to physicians, nurses, utilization review staff, and cross-functional business partners by providing education, guidance, and consultation on medical policy and clinical best practices.
Participate in interdisciplinary committees, physician advisory groups, and organizational meetings to provide clinical insight and support strategic initiatives.
Foster collaborative relationships with internal and external stakeholders to promote quality outcomes, regulatory compliance, and continuous improvement across medical management programs.
Perform other duties as assigned.

Requirements

What you’ll need

MD or DO degree with an active, unrestricted medical license
Board certification in a recognized specialty
Experience with utilization management, medical policy development, and clinical program oversight
Familiarity with applicable regulations (e.g., CMS, URAC, and state-specific requirements)
Strong interpersonal, organizational, and analytical skills
Active, unrestricted Texas medical license (full licensure, not an administrative license)
Must hold active medical licenses in states that require physician licensure to perform utilization reviews. Current priorities include Maryland, New Hampshire, West Virginia, and Texas. Additional state licenses are preferred as business needs evolve.

Benefits

Comp & perks

Competitive benefits package with generous employer subsidies
Flexible and remote working options
401k with generous employer match and immediate vesting
Personal and professional development opportunities
Supportive family benefits, including paid leave for new family members
Companywide philanthropic program, Valenz Communities Connection