2 jobs found

Quantum Health seeks a Medical Director Utilization Management to lead clinical strategy for its healthcare navigation and care coordination programs. In this role, you'll design and oversee evidence-based utilization management policies, guide complex case review, and ensure appropriate, cost effective care. You'll partner with analytics, tech, and clinical teams to interpret data, improve outcomes, and support regulatory compliance. Working in a collaborative, mission driven culture, you'll mentor clinicians, influence product innovation, and help transform the consumer healthcare experience. Responsibilities Lead clinical strategy for utilization management across Quantum Health programs Develop, implement, and oversee evidence-based medical necessity and utilization policies Review complex or escalated clinical cases and make coverage determinations Partner with data and analytics teams to monitor trends, costs, and quality outcomes Collaborate with provider networks,...

Description Who we are Founded in 1999 and headquartered in Central Ohio, we’re a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we’re on a mission to make 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, when 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 At Quantum Health, the leader in healthcare navigation, we are privileged and humbled to serve an amazing group of clients and members. As our relationships flourish and our...