Medical Director
About the role
Valenz Health is a healthcare technology company focused on simplifying the healthcare experience for employers, payers, providers, and members. Through an integrated platform spanning care navigation, medical management, payment integrity, plan performance, and provider verification, the company helps organizations reduce costs, improve quality, and enhance patient outcomes. With a strong emphasis on innovation and evidence-based care, Valenz partners with clients throughout the patient journey to deliver smarter, more transparent healthcare solutions.
Key Responsibilities
Provide physician leadership for medical management and utilization review programs.
Develop, implement, and maintain evidence-based clinical guidelines and medical policies.
Oversee medical necessity determinations for complex and escalated cases.
Ensure consistency and quality across clinical decision-making processes.
Monitor clinical practice guidelines and regulatory changes.
Participate in quality improvement initiatives, audits, accreditation activities, and Quality Committee meetings.
Ensure compliance with CMS, URAC, state regulations, and organizational standards.
Review medical management outcomes and recommend process improvements.
Partner with Clinical Operations, Compliance, Legal, and executive leadership on clinical policies and organizational initiatives.
Provide clinical consultation for appeals, post-service reviews, and medically complex cases.
Serve as a trusted advisor to physicians, nurses, utilization review staff, and business partners.
Participate in interdisciplinary committees and physician advisory groups.
Qualifications
MD or DO degree with an active, unrestricted medical license.
Board certification in a recognized medical specialty.
Experience in utilization management, medical policy development, and clinical program oversight.
Familiarity with CMS, URAC, and applicable state regulations.
Active unrestricted Texas medical license.
Additional state licenses preferred (Maryland, New Hampshire, West Virginia, Texas).
Strong interpersonal, organizational, analytical, and communication skills.
Preferred Qualifications
5+ years of clinical experience.
Managed care or health insurance industry experience.
Compensation
Competitive part-time compensation.
Comprehensive medical, dental, and vision insurance.
401(k) with company match and immediate vesting.
Generous paid time off and paid holidays.
Paid parental leave.
Employee Assistance Program and additional wellness benefits.
Time Commitment
Part-Time.
Fully remote within the United States.