Medical Director - Part Time

Valenz•Phoenix, AZ

10d•Remote

About The Position

As the Part-Time Medical Director, you'll provide physician leadership for the organization's medical management and utilization review programs. You'll help ensure clinical decisions, medical policies, and review processes align with evidence-based medicine, regulatory requirements, and organizational standards. In this role, you'll support quality improvement initiatives, complex medical necessity determinations, and the ongoing development of clinical programs while serving as a trusted clinical advisor to operational leadership and interdisciplinary teams.

Requirements

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.
US based, in a location where you can work effectively and comply with company policies such as HIPAA.

Nice To Haves

5+ years of clinical experience
Managed care or health insurance industry experience
Additional state licenses are preferred as business needs evolve.

Responsibilities

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.
Reasonable accommodation may be made to enable individuals with disabilities to perform essential duties.

Benefits

Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
Spending account options: HSA, FSA, and DCFSA
401K with company match and immediate vesting
Flexible working environment
Generous Paid Time Off to include vacation, sick leave, and paid holidays
Employee Assistance Program that includes professional counseling, referrals, and additional services
Paid maternity and paternity leave
Pet insurance
Employee discounts on phone plans, car rentals and computers
Community giveback opportunities, including paid time off for philanthropic endeavors