Health Network One

ABOUT HEALTH NETWORK ONE
Health Network One is a specialty benefits organization dedicated to improving access, quality, and value across dermatology, musculoskeletal, vision, and other specialty service lines. We partner with health plans, employers, and providers to deliver clinically sound, operationally efficient, and member-focused solutions. Our mission is to bring clinical expertise, integrity, and innovation to every aspect of the services we manage, ensuring high-quality outcomes for members while supporting our clients' strategic and financial goals.
POSITION SUMMARY
The Medical Director, Dermatology is a physician executive responsible for providing clinical leadership and oversight for Health Network One's dermatology programs and services. This role serves as the senior dermatology subject matter expert and is accountable for utilization management activities, including medical necessity determinations, appeals, and denials, while also acting as a client-facing clinical leader. Reporting to the Chief Medical Officer, the Medical Director partners with executive leadership, operations, and clients to ensure high-quality, compliant, and clinically sound dermatology services that align with the organization's mission and strategic objectives.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Clinical Leadership and Oversight
• Provide clinical oversight and medical direction for dermatology-related programs and services.
• Ensure clinical policies, guidelines, and practices align with evidence-based dermatology standards of care and applicable regulatory requirements.
• Serve as the senior clinical authority for dermatology-related questions, escalations, and complex case reviews.
Utilization Management, Appeals, and Denials
• Perform and oversee utilization management reviews related to dermatology services.
• Conduct medical necessity determinations for prior authorization, concurrent review, and retrospective review.
• 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.
Client-Facing Clinical Leadership
• Act as a client-facing clinical leader and dermatology specialist for Health Network One's dermatology service lines.
• Participate in client meetings, presentations, and consultations to explain dermatology clinical programs, utilization management decisions, and outcomes.
• Support client relationships, retention, and growth by providing credible, data-driven clinical guidance.
• Represent Health Network One with external stakeholders, including health plans, provider partners, and regulatory entities, as appropriate.
Strategic and Executive Partnership
• Partner with the Chief Medical Officer and executive leadership team to support strategic planning, clinical program design, and growth initiatives for dermatology 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.
Compliance and Quality
• Ensure compliance with federal and state regulations, accreditation standards, and client contractual requirements.
• Support quality management activities related to dermatology services, including audits, reporting, and corrective action planning.
• Promote a culture of clinical excellence, accountability, and patient-centered decision-making.
QUALIFICATIONS
Required
• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) with specialty training in Dermatology.
• 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 Dermatology.
• 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.
Preferred
• Experience in managed care, health plans, MSOs, or delegated dermatology or specialty services.
• Prior experience in a physician executive or client-facing clinical leadership role.
• Familiarity with regulatory and accreditation standards related to utilization management and quality programs.
KEY COMPETENCIES
• Physician executive judgment and credibility
• Dermatology clinical expertise
• Client-facing communication and presentation skills
• Strong clinical decision-making and documentation
• Ability to balance clinical integrity with operational and business priorities
• Collaborative, strategic leadership approach
Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.