About Company

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.

The Role

Valenz Health is seeking a Part-Time Medical Director to provide physician leadership for the organization's medical management and utilization review programs. This executive leadership role is responsible for ensuring that clinical decisions, medical policies, and utilization management processes align with evidence-based medicine, regulatory requirements, and organizational standards.

The Medical Director will collaborate closely with executive leadership and cross-functional teams to support quality improvement initiatives, oversee complex medical necessity determinations, and guide the ongoing development of clinical programs.

Key Responsibilities

Clinical Leadership

• 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.

Quality & Compliance

• 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.

Strategic Collaboration

• 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.
• Active medical licenses in states requiring physician licensure for utilization review (Maryland, New Hampshire, West Virginia, Texas); additional state licenses are preferred.
• 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.
• Flexible remote work environment.
• Paid parental leave.
• Employee Assistance Program and additional wellness benefits.

Time Commitment

• Part-Time.
• Fully remote within the United States.

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