Medical Director, Vision

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🕒 May 13

🐊 Florida – Remote

🐊 Florida – Remote

💵 $275k - $325k / year

⏰ Full Time

🔴 Lead

👨‍⚕️ Medical Director

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Health Network One

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1999

⚕️ Healthcare Insurance

🤝 B2B

Healthcare Insurance • B2B

Health Network One is a healthcare network management company that partners with health plans to manage specialty outpatient services (including outpatient therapy, routine and medical eye care, dermatology, and podiatry) under full-risk arrangements. The company operates nationally, covering over 7 million lives and contracting with tens of thousands of providers, and offers delegated services such as utilization management, credentialing, claims and network management. Health Network One emphasizes value‑based solutions, clinical quality, cost reduction for professional and facility spend, and holds NCQA accreditation and HITRUST CSF certification.

📋 Description

• Provide clinical oversight and medical direction for vision related programs and services. • Ensure clinical policies, guidelines, and practices align with evidence based ophthalmology standards and applicable regulatory requirements. • Serve as the senior clinical authority for ophthalmology related questions, escalations, and complex case reviews. • Ensure compliance with GAAP, healthcare-specific regulations, and internal policies. • Perform and oversee utilization management reviews related to ophthalmology and vision services. • Conduct medical necessity determinations for prior authorization, concurrent, and retrospective reviews. • Review and adjudicate clinical appeals and denials, including peer to peer discussions with ordering and rendering providers. • Collaborate with operational and compliance teams to ensure utilization management activities meet contractual, regulatory, and accreditation standards. • Act as a client‑facing clinical leader and ophthalmology specialist for Health Network One’s vision service lines. • Participate in client meetings, presentations, and consultations to explain clinical programs, utilization management decisions, and outcomes. • Support client relationships, retention, and growth by providing credible, thoughtful clinical guidance. • Represent Health Network One with external stakeholders, including health plans, provider partners, and regulatory entities, as appropriate. • Partner with the CEO and executive leadership team to support strategic planning, clinical program design, and growth initiatives for vision services. • Provide clinical insight to inform organizational decision making, risk management, and performance improvement efforts. • Contribute to the development and refinement of clinical workflows, quality initiatives, and performance metrics aligned with organizational goals. • Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements. • Support quality management activities related to ophthalmology and vision services, including audits, reporting, and corrective action planning. • Promote a culture of clinical excellence, accountability, and patient centered decision making.

🎯 Requirements

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with specialty training in Ophthalmology. • Active, unrestricted medical license in at least one U.S. state, with the ability to obtain additional licensure as needed. • Board certified or board eligible in Ophthalmology. • Demonstrated experience with utilization management, medical necessity review, appeals, and denials. • Strong executive level communication skills, including the ability to engage effectively with clients, providers, and senior leaders. • Experience in managed care, health plans, MSOs, or delegated specialty or vision services (preferred). • Prior experience in a physician executive or client facing clinical leadership role (preferred). • Familiarity with regulatory and accreditation standards related to utilization management and quality programs (preferred).