Quantum Health

Description

Location: This position may work remotely anywhere in the United States of America with significant business travel to and from prospect/client sites and/or the Quantum Health home office in Dublin, OH.

Who we are

Founded in 1999 and headquartered in Central Ohio, we're a privately-owned, independent healthcare navigation organization. We believe that no one should have to navigate the cost and complexity of healthcare alone, and we're on a mission to make healthcare simpler and more effective for our millions of members. Our big-hearted, tech-savvy team fights to ensure that our members get the care they need, when they need it, at the most affordable cost - that's why we call ourselves Healthcare Warriors(R).

We're committed to building diverse and inclusive teams - more than 2,000 of us and counting - so if you're excited about this position, we encourage you to apply - even if your experience doesn't match every requirement.

About the role

The Medical Director - Medical Management and Client Partnerships role offers a unique and dynamic opportunity to blend deep expertise in Utilization and Case/Care Management with strategic clinical partnership. This position serves as a key clinical resource for our account management teams, providing expert insights that reinforce Quantum's clinical model and support client engagement efforts. In addition to delivering strategic guidance, the Account Management Medical Director collaborates closely with our clinical team to conduct daily reviews, ensuring alignment with best practices and optimal member outcomes.

The Ideal Candidate Will Bring

• Proven subject matter expertise in Utilization Management and Case Management
• Strong knowledge of the healthcare market
• Experience in client-facing roles
• A passion for improving health outcomes and driving clinical excellence

What you'll do

• Client Engagement & Strategy
• Act as a clinical consultant and strategic partner to key employer group clients through a consultative, service-oriented clinical relationship to maximize client satisfaction, contract renewals, and adoption of new or expanded use of Quantum's products and services.
• Participate in developing and delivering semiannual and annual reviews for client meetings to represent Quantum's clinical operating model and actively support alignment between the clinical operating model and the clinical and benefit strategy for the client.
• Health Data Analysis & Reporting
• Translate complex clinical trends and data into actionable insights for benefit strategy and wellness programming.
• Translate population health data into actionable, strategic recommendations tailored to client goals.
• Interpret medical and pharmacy claims, biometrics, and engagement data to identify cost drivers, care gaps, and population health risks.
• Recommend benefits and programs, as well as other interventions based on clinical data and ROI potential
• Deliver clear, compelling presentations and reports on clinical outcomes and trends.
• Stakeholder Communication & Leadership
• Serve as the voice of the client's health goals, ensuring that clinical programming aligns with workforce needs.
• Educate client stakeholders and brokers on trends in population health, cost containment, and value-based care.
• Serve as the primary point of escalation for complex client inquiries or concerns.
• Ensure that all clinical recommendations adhere to evidence-based guidelines and regulatory requirements.
• Provide clinical impact narratives and documentation to support renewal conversations and upsell opportunities.
• Support Account Managers in articulating the clinical value of services provided.
• Serve as a key clinical resource for staff. Establishes criteria and protocols for standard medical treatment inquiries and renders determinations on requests for healthcare services and/or treatment.
• Conduct daily review of individual cases and have necessary case level conversations as requested. This includes prior authorizations and denial decisions for cases that do not meet established evidence-based criteria.
• Provide clear and concise documented medical review determinations and support on requested reviews within the established time frames.
• Provide clinical and nurse consultations.
• Identify opportunities to implement best practices approaches and introduce innovations to provide improved outcomes.
• Perform utilization review and case management support on complex members.
• Offer peer-to-peer discussions regarding determinations as necessary.
• Serve as a medical liaison to physicians, hospitals and insurance carriers.
• Provides determination on appeals for cases where they did not make the initial determination.
• Other duties as assigned

What you'll bring

• Licensure/Certifications: Current, unrestricted license to practice medicine required and the ability to become multistate licensed. Board certification in primary specialty required.
• Five years of progressively related clinical work / practice experience required
• Two years of physician clinical review in the preferably in the commercial health plan setting
• Two years of externally facing client and partner experience in network, quality, and sales/account management
• Strong written and verbal communication skills
• Team oriented and a collaborative mindset
• Knowledge of health care delivery system
• Knowledge of utilization management and InterQual criteria
• Reflects both senior leadership, clinical expertise, and strategic client partnership capabilities
• Proficiency required in understanding market trends, insights, clinical models, and managed care systems
• Strong analytical skills with the ability to interpret complex clinical data and translate it into presentations and actionable insights for clinical and non-clinical stakeholders
• Exceptional presentation and communication skills, with experience presenting to clients on the health outcomes of the client population and contributions to cost savings through clinical program recommendations.
• Ability to work collaboratively with cross-functional teams and external consultants.
• Strong organizational skills and the ability to manage multiple projects simultaneously.
• Understanding of client retention strategies and satisfaction (NPS, renewal rates)
• Travel is expected to various client headquarters throughout the country. The travel amount varies throughout the year, but overall, the expected travel percentage is 50%.
• Strong administrative/technical skills; Comfort working on a PC using Microsoft Office (Outlook, Word, Excel, PowerPoint), IM/video conferencing (Teams & Zoom), and telephones efficiently.
• A high degree of personal accountability and trustworthiness, a commitment to working within Quantum Health's policies, values and ethics, and to protecting the sensitive data entrusted to us.

#LI-HW1 #LI-Remote What's in it for you

• Compensation: Competitive base and incentive compensation
• Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.
• Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
• Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
• Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.
• Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.
• Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more!

What you should know

• Internal Associates: Already a Healthcare Warrior? Apply internally through Jobvite.
• Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background Check.
• Diversity, Equity and Inclusion: Quantum Health welcomes everyone. We value our diverse team and suppliers, we're committed to empowering our ERGs, and we're proud to be an equal opportunity employer .
• Tobacco-Free Campus: To further enable the health and wellbeing of our associates and community, Quantum Health maintains a tobacco-free environment. The use of all types of tobacco products is prohibited in all company facilities and on all company grounds.
• Compensation Ranges: Compensation details published by job boards are estimates and not verified by Quantum Health. Details surrounding compensation will be disclosed throughout the interview process. Compensation offered is based on the candidate's unique combination of experience and qualifications related to the position.
• Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship.
• Agencies: Quantum Health does not accept unsolicited resumes or outreach from third-parties. Absent a signed MSA and request/approval from Talent Acquisition to submit candidates for a specific requisition, we will not approve payment to any third party.

Reasonable Accommodation: Should you require reasonable accommodation(s) to participate in the application/interview/selection process, or in order to complete the essential duties of the position upon acceptance of a job offer, click here to submit a recruitment accommodation request.

Recruiting Scams: Unfortunately, scams targeting job seekers are common. To protect our candidates, we want to remind you that authorized representatives of Quantum Health will only contact you from an email address ending in @quantum-health.com. Quantum Health will never ask for personally identifiable information such as Date of Birth (DOB), Social Security Number (SSN), banking/direct/tax details, etc. via email or any other non-secure system, nor will we instruct you to make any purchases related to your employment. If you believe you've encountered a recruiting scam, report it to the Federal Trade Commission and your state's Attorney General.