Medical Director, Hematology/Oncology | BMT

Medical Director, Transplantation And Cellular TherapiesOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.Transplant Resource Solutions is seeking a board-certified Medical Director with expertise in transplantation and cellular therapies. In this individual contributor role, the Medical Director serves as a clinical subject matter expert, providing physician support to Enterprise Clinical Services and collaborating with internal and external stakeholders to support evidence-based clinical decision-making.This physician applies specialized transplant knowledge to utilization management activities, benefit coverage determinations, quality programs, and Centers of Excellence evaluations. The Medical Director partners with clinical and operational teams to assess complex transplant-related issues, interpret evolving clinical evidence, and support consistent, high-quality coverage decisions for members. The role requires extensive collaboration with network and non-network physicians, provider organizations, and client stakeholders while serving as a trusted clinical resource across transplant and cellular therapy programs.You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:Serve as a clinical subject matter expert for solid organ transplantation, blood and marrow transplantation (BMT), stem cell transplantation, CAR-T therapies, and emerging cellular therapiesApply clinical expertise to support benefit coverage determinations, medical necessity reviews, and utilization management activitiesParticipate in the evaluation and enhancement of transplant and cellular therapy clinical guidelines and Centers of Excellence (COE) criteriaReview and interpret emerging clinical evidence, industry trends, and regulatory developments related to transplantation, cellular therapies, gene therapies, and hematologic malignanciesCollaborate with internal and external stakeholders to assess quality outcomes, accreditation standards, clinical performance measures, and COE qualificationsProvide clinical consultation and expertise in support of new business opportunities, client renewals, and program development activitiesParticipate in client-facing discussions, clinical consultations, and program reviews related to transplant and cellular therapy servicesBuild collaborative relationships with client medical directors, physician leaders, provider organizations, and transplant centersSupport provider qualification, designation, and performance review activities for transplant and cellular therapy Centers of ExcellenceAnalyze clinical and operational data to identify trends, opportunities, and areas for improvement in quality, utilization, and member outcomesSupport peer-to-peer discussions and clinical consultations regarding transplant-related coverage determinations and complex clinical casesRepresent the organization at professional meetings, conferences, and industry organizations, including NMDP, UNOS, SRTR, and CIBMTRYou'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) degreeCurrent, unrestricted physician licenseBoard certification through an ABMS or AOA recognized specialty boardSpecialized expertise in Hematology/Oncology with experience in Blood and Marrow Transplantation (BMT), stem cell transplantation, CAR-T therapy, immune effector cell therapies, or related cellular therapy programs5+ years of clinical experience in transplantation and/or cellular therapy, including transplant patient care, transplant program operations, blood and marrow transplantation (BMT), stem cell transplantation, CAR-T therapy, transplant-related medical management, or utilization managementExperience evaluating clinical literature, evidence-based guidelines, quality metrics, and healthcare outcomesExperience utilizing clinical and operational data to support quality improvement and performance optimization initiativesKnowledge of NCQA, URAC, CMS, and applicable state and federal regulatory requirementsDemonstrated ability to collaborate effectively with multidisciplinary teams and influ