• Perform all types of utilization management (UM) reviews, including but not limited to Pre-service, Post-service, Concurrent Review and Appeals • Discuss cases with physician providers (Peer to Peer) • Apply health plan review hierarchy to member contracts, medical policy, clinical guidelines and other approved resources to render timely decisions on medical necessity requests • Collaborate with Case Managers to provide support and guidance on cases needing physician assistance • Meet any established metrics (compliance and accreditation) related to UM review efficiency, timeliness, and quality of review • Participate in ongoing Inter-rater reliability (IRR) audits and any other health plan audits as necessary • As necessary, assist nurses and other staff in understanding the principles behind appropriate utilization review and interpretation and application of benefits and policies • Participate in the development and review of Medical and Pharmacy policies as assigned • Support the organization as a subject matter expert • Perform as lead Medical Director consultant for one sub-category of utilization management, such as commercial or Medicare medical policy • Perform other duties as assigned and needed by the organization

• Provide national medical oversight of all utilization management functions, ensuring alignment with organizational goals and compliance with regulatory and accreditation standards. • Serve as a clinical resource and subject matter expert to utilization management nurses, case managers, and other clinical staff. • Conduct peer reviews and clinical reviews for medical necessity determinations, complex cases, and high-cost claims. • Participate in inter-rater reliability assessments to ensure consistency and accuracy of medical review decisions. • Collaborate with Quality and Risk Adjustment teams on MRA and quality education initiatives to enhance outcomes and compliance. • Partner with leadership to develop and refine utilization management policies, protocols, and criteria based on nationally recognized standards (e.g., MCG, InterQual). • Contribute medical expertise to case management and care coordination processes, ensuring members transition to the appropriate level of care. • Support physician engagement, education, and alignment through clear communication and collaboration with internal and external providers. • Participate in ongoing evaluation and improvement of UM operations, including metrics monitoring and performance review. • Perform other duties as assigned to support clinical and operational initiatives.

• Initiate and maintain medical and consultative relationships with clients • Independently deliver all medical support required for successful delivery of the projects • Provide training of study teams on TA indication and protocol • Deliver medical monitoring activities according to MMP during the study conduct • Actively listen to, solicit and address client feedback and suggestions regarding medical study-related activities • Support Business Development as a core priority while adequately balancing time with billable tasks • Work with Section Head to develop expertise in therapeutic area; provide medical expertise/leadership in multiple channels and interactions • Create a culture of continuous improvement and lead team through change

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Our product is a second opinion-like treatment report for cancer patients. We’re seeking an oncologist to review and refine these reports, directly shaping how our AI models learn, reason, and deliver clinical insight at scale. Qualifications - MD or DO, board-certified or board-eligible in Medical Oncology (or Hematology/Oncology). - High intellectual curiosity about data, AI, and clinical decision-support systems—you don’t need to code, but you enjoy thinking about how models reason and where they fail. - Interest in working in a fast-moving, early-stage environment, collaborating closely with founders, researchers, and product teams. Requirements - MD or DO, board-certified or board-eligible in Medical Oncology (or Hematology/Oncology). - High intellectual curiosity about data, AI, and clinical decision-support systems—you don’t need to code, but you enjoy thinking about how models reason and where they fail. - Interest in working in a fast-moving, early-stage environment, collaborating closely with founders, researchers, and product teams. Benefits - Health, dental, and vision insurance. - Flexible PTO and hybrid work options. - Professional development and conference support. - The rare opportunity to redefine how cancer care is delivered.