quantum-health
OR
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,...
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Administration & Operations
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