The Oncology Institute · 7 hours ago
Senior Medical Director Utilization Management Oncology
United States
Full-time
Remote
Senior Level, Lead/Staff, Director/Executive
$272K/yr - $370K/yr
5+ years expThe Oncology Institute is advancing oncology by delivering highly specialized, value-based cancer care in the community setting. As a Senior Medical Director, Utilization Management, you will provide medical and strategic oversight of utilization management while leading a clinical team to ensure cost-effective and evidence-based oncology treatments.
Health CareHealth DiagnosticsHome Health CareMedicalOncologyPsychology
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
Qualification
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
The Oncology Institute
Founded in 2007, The Oncology Institute (NASDAQ: TOI) is advancing oncology by delivering highly specialized, value-based cancer care in the community setting.
501-1000 employees
Funding
Current Stage
Public CompanyTotal Funding
$291.5MKey Investors
Deerfield
2025-03-24Post Ipo Equity· $16.5M
2021-11-15Post Ipo Equity· $275M
2021-11-15IPO
Leadership Team
Daniel Virnich
Board Member
Jeffrey Langsam
Chief Clinical Officer
Recent News
2026-01-11
2026-01-10
2026-01-05
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