Medical Director

Job Description

Job Description

Description :

Our client, a leading health insurance organization, is seeking an accomplished Medical Director to join their executive team. This role offers the opportunity to make a significant impact on healthcare delivery, driving innovation and ensuring members receive high-quality, cost-effective care.

About the Role

The Medical Director will provide clinical leadership and oversight across utilization management, medical policy, and quality improvement initiatives. The successful candidate will work closely with executive leadership, provider networks, and clinical teams to ensure compliance, enhance care standards, and improve member outcomes.

Key Responsibilities

• Lead medical oversight for utilization management, case management, and clinical review processes.
• Evaluate complex medical cases for medical necessity and cost-effectiveness.
• Guide the development and implementation of medical policies and care standards.
• Ensure regulatory and accreditation compliance across programs.
• Collaborate with provider networks to strengthen relationships and maintain quality standards.
• Mentor and support clinical teams, promoting evidence-based best practices.
• Analyze clinical data to identify trends, risks, and opportunities for improvement.

Requirements :

Compensation & Benefits