Medical Director, Vision

This is a fully remote position, open to applicants in Florida.

📋 Description

• Provide clinical oversight and medical direction for programs and services related to vision.

• Ensure that clinical policies, guidelines, and practices conform to evidence-based ophthalmology standards and relevant regulatory requirements.

• Act as the senior clinical authority for inquiries related to ophthalmology, escalations, and reviews of complex cases.

• Guarantee compliance with GAAP, healthcare-specific regulations, and internal policies.

• Conduct and supervise utilization management reviews associated with ophthalmology and vision services.

• Make determinations regarding medical necessity for prior authorization, concurrent, and retrospective reviews.

• Review and adjudicate clinical appeals and denials, including engaging in peer-to-peer discussions with ordering and rendering providers.

• Collaborate with operational and compliance teams to ensure that utilization management activities align with contractual, regulatory, and accreditation standards.

• Serve as a client-facing clinical leader and ophthalmology expert for Health Network One’s vision service lines.

• Participate in client meetings, presentations, and consultations to clarify clinical programs, utilization management decisions, and outcomes.

• Strengthen client relationships, retention, and growth by offering credible and insightful clinical guidance.

• Represent Health Network One to external stakeholders, including health plans, provider partners, and regulatory entities as needed.

• Collaborate with the CEO and executive leadership team to assist in strategic planning, clinical program design, and growth initiatives for vision services.

• Provide clinical insights to guide organizational decision-making, risk management, and performance improvement efforts.

• Contribute to the creation and enhancement of clinical workflows, quality initiatives, and performance metrics that align with organizational objectives.

• Ensure adherence to federal and state regulations, accreditation standards, and client contractual obligations.

• Support quality management activities linked to ophthalmology and vision services, including audits, reporting, and corrective action planning.

• Foster a culture of clinical excellence, accountability, and patient-centered decision-making.

⛳️ Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with specialized training in Ophthalmology.

• An active, unrestricted medical license in at least one U.S. state, with the capability to obtain additional licensure as required.

• Board certified or board eligible in Ophthalmology.

• Proven experience in utilization management, medical necessity review, appeals, and denials.

• Excellent executive-level communication skills, with the ability to engage effectively with clients, providers, and senior leaders.

• Experience in managed care, health plans, MSOs, or delegated specialty or vision services is preferred.

• Prior experience in a physician executive or client-facing clinical leadership position is preferred.

• Familiarity with regulatory and accreditation standards related to utilization management and quality programs is preferred.

🏝️ Benefits

• Competitive salary and performance-based incentives.

• Comprehensive health benefits including medical, dental, and vision coverage.

• Opportunities for professional development and continuing education.

• Supportive work environment that promotes work-life balance.

• Retirement savings plan with company match.