Founded in 2007, The Oncology Institute of Hope and Innovation (TOI) is the largest community oncology practice on the west coast, and the nation’s leading value-based oncology services platform. TOI employs 80+ physicians and mid-levels in 45 clinic locations, with over 550 total employees helping to deliver cutting edge, evidence-based cancer care to a population of over 1 million patients. TOI is headquartered in Cerritos, CA, and serves patients throughout California, Arizona, Nevada, and Florida.

TOI brings comprehensive, integrated cancer care into community settings, offering patients modern infusion centers, chemotherapy educational sessions, in-house support groups, dietary and nutritional counselling, in-house pharmacy, financial counseling, comprehensive lab testing, advanced care planning, and end-of-life counseling.

TOI’s size and scope allow it to serve patients in ways most community-based oncology practices cannot. TOI’s distinctive capabilities include Clinical Trials, Palliative Care programs, Stem Cell Transplants, Transfusions, and other care delivery models more traditionally associated with tertiary care settings. TOI contracts with health plans, health systems, governmental agencies, and medical groups on an at-risk basis, taking accountability for the medical costs and the health outcomes of its patient population.

This is a unique opportunity to join a high-growth Value-Based Care organization backed by notable growth equity investors. This position can be based in Cerritos, CA or Tampa, FL.

The Senior Medical Director of Utilization Management is responsible for ensuring clinical appropriateness of therapy regimes for TOI patients in a manner that is consistent with our value-based model. The position is responsible for overall quality, effectiveness, and coordination of the Utilization Management programs provided by TOI. As the lead physician for TOI’s Utilization Management program, the position reports directly to the Chief Clinical Officer.

Core Responsibilities

· Leads efforts to ensure consistency of clinical decision-making by assuring all physicians are aware of current client and TOI clinical criteria

· Provides professional direction and leadership to set the goals and objectives for UM team

· Provides oversight for other UM Medical Directors

· Provides clinical expertise to UM projects

· Serves as liaison between providers and managed care partners in UM related issues

· Is an active UM reviewer that actively interfaces with providers regarding evidence-based and value-based practice patterns

· Evaluates utilization management program effectiveness and recommends improvements

  • Ensures provider satisfaction with utilization management program
  • Monitors relevant clinical and financial data relating to UM activities and works with senior management to further improve overall company performance
  • Participates in the development and implementation of policies and procedures to ensure effective monitoring and management of UM activities
  • With CCO, develops and implements methods, policies, and procedures to improve the departments efficiency and effectiveness

· Collaborate with business development and operational leadership on contracting and deployment efforts in new markets to ensure successful integration into UM framework

Requirements

· Board certified in hematology and oncology

· Minimum of 5 years post-graduate experience in clinical practice/patient care.

· Minimum of 2 years experience managing professional medical staff and leading teams of physicians

  • Must possess knowledge of managed care operations
  • Must have demonstrated interpersonal, negotiation, and leadership skills

Must have effective oral and written communication skills

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