The Oncology Institute
Senior Medical Director Utilization Management Oncology
This leadership role involves providing medical and strategic oversight of utilization management in oncology, guiding evaluation of clinical necessity and appropriateness of treatments to ensure cost-effective, evidence-based care. The role includes leading and developing a clinical Utilization Management team and collaborating with executive, clinical, and operational leaders to align on clinical guidelines and patient-focused care.
Key Responsibilities
- • Provide strategic and clinical leadership to the Utilization Management team, fostering high performance, accountability, and consistent application of evidence-based oncology standards.
- • Build trusted relationships with the Utilization Management team and TOI and affiliated physicians to drive alignment on clinical guidelines, utilization decisions, and patient focused care.
- • Coach and educate the Utilization Management team and physicians on oncology utilization standards, fostering shared accountability for quality, cost effective patient care.
- • Development of strategy development to support scalable growth across TOI network.
- • Conduct medical reviews of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices.
- • Evaluate clinical data and collaborate with healthcare providers to ensure optimal utilization of resources for oncology patients.
- • Make independent clinical decisions on the appropriateness of treatments, imaging, and interventions based on established medical standards.
- • Provide expert guidance and recommendations on appropriate oncology treatments while considering cost-effectiveness and patient care quality.
- • Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage.
- • Ensure compliance with organizational policies, regulatory standards, and payer requirements in all clinical decisions.
- • Participate in the development and continuous improvement of utilization management protocols and criteria specific to oncology.
- • Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices.
Required
- • Medical degree (MD or DO)
- • Board Certification in Oncology.
- • Minimum of 5 years of clinical experience in oncology.
- • 3+ years of Utilization Management leadership experience
- • Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans.
- • Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies.
- • Excellent analytical skills and the ability to evaluate complex clinical data.
- • Ability to work independently and make evidence-based decisions in a collaborative, multidisciplinary setting.
- • Excellent communication skills to engage effectively with healthcare providers, payers, and patients.
Company Overview
Industry: Healthcare Technology
Company Size: 500-1,000 employees
Founded: 2015
Headquarters: San Francisco, CA
Company Links
Key Contacts
Contact information not available
About the Company
Leading healthcare technology company focused on improving patient outcomes through innovative digital solutions. We're transforming the way healthcare is delivered with cutting-edge technology and data-driven insights. Our platform serves over 10,000 healthcare professionals and has processed millions of patient interactions.
Recent News & Updates
Series B
Raised $50M Series B funding - Jan 2024
Award
Named "Best Healthcare Startup" by TechCrunch - Dec 2023
Growth
Expanded to 5 new states - Nov 2023
About The Oncology Institute (www.theoncologyinstitute.com):
Founded in 2007, The Oncology Institute (NASDAQ: TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI offers cutting-edge, evidence-based cancer care to a population of approximately 1.9 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With over 180 employed and affiliate clinicians and over 100 clinics and affiliate locations of care across five states and growing, TOI is changing oncology for the better.
Senior Medical Director Utilization Management Oncology
Work Location: REMOTE (work from home)
California Nevada Arizona Oregon Florida
As a Senior Medical Director, Utilization Management, you will report directly to the Chief Clinical Officer and support key C-suite clinical initiatives. This is a leadership role with responsibility for providing medical and strategic oversight of utilization management while leading and developing a clinical Utilization Management team. You will guide the evaluation of the clinical necessity and appropriateness of oncology treatments, ensuring cost-effective, evidence-based care without compromising patient outcomes, while partnering closely with executive, clinical, and operational leaders across the organization.
Key Responsibilities:
Pay Transparency for salaried teammates
$272,000—$370,000 USD
Founded in 2007, The Oncology Institute (NASDAQ: TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. TOI offers cutting-edge, evidence-based cancer care to a population of approximately 1.9 million patients, including clinical trials, transfusions, and other care delivery models traditionally associated with the most advanced care delivery organizations. With over 180 employed and affiliate clinicians and over 100 clinics and affiliate locations of care across five states and growing, TOI is changing oncology for the better.
Senior Medical Director Utilization Management Oncology
Work Location: REMOTE (work from home)
California Nevada Arizona Oregon Florida
As a Senior Medical Director, Utilization Management, you will report directly to the Chief Clinical Officer and support key C-suite clinical initiatives. This is a leadership role with responsibility for providing medical and strategic oversight of utilization management while leading and developing a clinical Utilization Management team. You will guide the evaluation of the clinical necessity and appropriateness of oncology treatments, ensuring cost-effective, evidence-based care without compromising patient outcomes, while partnering closely with executive, clinical, and operational leaders across the organization.
Key Responsibilities:
- Provide strategic and clinical leadership to the Utilization Management team, fostering high performance, accountability, and consistent application of evidence-based oncology standards.
- Build trusted relationships with the Utilization Management team and TOI and affiliated physicians to drive alignment on clinical guidelines, utilization decisions, and patient focused care.
- Coach and educate the Utilization Management team and physicians on oncology utilization standards, fostering shared accountability for quality, cost effective patient care.
- Development of strategy development to support scalable growth across TOI network.
- Conduct medical reviews of hematology and oncology treatment plans to determine medical necessity, appropriateness, and alignment with value-based clinical guidelines and evidence-based practices.
- Evaluate clinical data and collaborate with healthcare providers to ensure optimal utilization of resources for oncology patients.
- Make independent clinical decisions on the appropriateness of treatments, imaging, and interventions based on established medical standards.
- Provide expert guidance and recommendations on appropriate oncology treatments while considering cost-effectiveness and patient care quality.
- Liaise with providers, insurance companies, and patients to clarify and discuss treatment options and coverage.
- Ensure compliance with organizational policies, regulatory standards, and payer requirements in all clinical decisions.
- Participate in the development and continuous improvement of utilization management protocols and criteria specific to oncology.
- Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that they align with evidence-based medicine and clinical best practices.
- Medical degree (MD or DO)
- Board Certification in Oncology.
- Minimum of 5 years of clinical experience in oncology.
- 3+ years of Utilization Management leadership experience
- Proven expertise in Utilization Management or experience with reviewing clinical appropriateness of treatment plans.
- Strong understanding of oncology-specific treatment protocols, guidelines, and reimbursement policies.
- Excellent analytical skills and the ability to evaluate complex clinical data.
- Ability to work independently and make evidence-based decisions in a collaborative, multidisciplinary setting.
- Excellent communication skills to engage effectively with healthcare providers, payers, and patients.
Pay Transparency for salaried teammates
$272,000—$370,000 USD
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