Medical Director - Part Time

About the role

This opportunity serves as the Part-Time Medical Director for Valenz Health, leading medical management and utilization review programs. Your responsibilities include providing physician leadership, ensuring alignment with evidence-based medicine, and supporting quality improvement initiatives.

Responsibilities

• Provide physician leadership in the development, implementation, and ongoing evaluation of evidence-based clinical guidelines, medical policies, and utilization management protocols.
• 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.
• Promote clinical standards integration into utilization review workflows, fostering 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.
• 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.

Requirements

Required Qualifications:

• 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
• Licensure Requirements: 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 (Maryland, New Hampshire, West Virginia, and Texas)
• Additional state licenses are preferred as business needs evolve

What You’ll Bring to the Team

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

Qualifications

Required Qualifications:

• 5+ years of clinical experience
• Managed care or health insurance industry experience

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

Where You’ll Work

This is a fully remote position, and we’ll provide all the necessary equipment!

Work Environment

You’ll need a quiet workspace that is free from distractions. Technology: Reliable internet connection—if you can use streaming services, you’re good to go! Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software. Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.

Why You'll Love Working Here

Valenz is proud to be recognized by Inc. 5000 as one of America’s fastest-growing private companies. Our team is committed to delivering on our promise to engage early and often for smarter, better, faster healthcare. With this commitment, you’ll find an engaged culture – one that stands strong, vigorous, and healthy in all we do.