Senior Medical Director

Molina Healthcare • Orem, UT • 4h ago

JOB DESCRIPTION Job SummaryLeads and manages a team of medical directors delivering oversight and expertise in appropriateness and medical necessity of services provided to members - ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

Leads a team of medical directors responsible for assessing appropriateness and medical necessity of health care services provided to plan members.

Provides leadership and expertise in performance of prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT) activities.

Recruits, hires, trains, mentors and develops medical director staff as needed.

Ensures that authorization decisions are rendered by qualified medical personnel and without hindrance due to fiscal or administrative incentives.

Analyzes data and identifies medical cost-savings and quality improvement opportunities.

Accounts for regulatory and accreditation performance of assigned team and responds to inquiries, issues and complaints from government and accreditation regulators.

Develops medical policies and procedures as needed.

Conducts peer review processes.

Required Qualifications

At least 8 years of relevant experience, including clinical practice experience, and at least 2 years as a medical director in managed care setting supporting utilization management/quality management initiatives, or equivalent combination of relevant education and experience.

At least 3 years management/leadership experience.

Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice.

Board Certification.

Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff.

Demonstrated ability to make strategic decisions.

Knowledge of health care regulatory and legislative processes, including ability to read and interpret legislation.

Experience gaining consensus, and collaborating in a highly matrixed organization.

Experience demonstrating strong leadership, communication, consensus building, collaboration and financial acumen abilities.

Evidence-based clinical criteria competency.

Peer review, medical policy/procedure development, and provider contracting experience.

Strong verbal and written communication skills.

Microsoft Office suite/applicable software program(s) proficiency.

Preferred Qualifications

Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other Health care or management certification.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $214,132 - $417,557 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Similar Jobs

Senior Medical Director

Molina Healthcare • Provo, UT • 4h ago

Hospital & Medical

4h ago

Go to Apply

Advanced Practice Provider-Medical Oncology

Intermountain Health • Saratoga Springs, UT • 10h ago

Hospital & Medical

Job Description: When you join us, you'll become a part of a nationally recognized health system dedicated to our mission of "helping people live the healthiest lives possible." We are excited to announce a new Medical O...

10h ago

Go to Apply

Neonatal Rehab Therapist

Intermountain Health • Provo, UT • 16h ago

Hospital & Medical

Job Description: This position is responsible for screening, testing, evaluating, diagnosing and treatment of injuries, diseases, and disabilities using therapy procedures and modalities in accordance with standard thera...

16h ago

Go to Apply

Entry Level Hospital Services Technician

STERICYCLE, INC. • Provo, UT • 19h ago

Hospital & Medical

$20.19/hr 7AM Start Time and Great Benefits About Us: Stericycle is now part ofWM!!!To learn more about WM's acquisition of Stericycle,CLICK HEREto read the press release! Stericycle is a U.S. based business-to-business...

19h ago

Go to Apply

Entry Level Hospital Services Technician

WM • Provo, UT • 1d ago

Hospital & Medical

$20.19/hr 7AM Start Time and Great Benefits About Us: Stericycle is now part of WM !!! To learn more about WM's acquisition of Stericycle, CLICK HERE ( https://investors.wm.com/news-releases/news-release-details/wm-compl...

1d ago

Go to Apply

Medical Assistant Electrophysiology

Intermountain Health • Provo, UT • 3d ago

Hospital & Medical

Job Description: A Medical assistant has accountability for providing care to patients in an ambulatory clinic setting. This will involve caring for patients with acute and chronic needs. A Medical Assistant will be resp...

3d ago

Go to Apply

Medical Assistant Cardiology

Intermountain Health • Provo, UT • 3d ago

Hospital & Medical

3d ago

Go to Apply

Medical Assistant Orthopedics

Intermountain Health • Provo, UT • 4d ago

Hospital & Medical

Job Description: Shift Details : Full-Time (40 hrs/wk - Monday to Friday 8AM to 5PM) Unit/Location: Utah Valley Orthopedics Additional Details: Please review Minimum Qualifications listed below before applying. Are you i...

4d ago

Go to Apply

Musculoskeletal Clinic Outpatient Nurse (RN)

University of Utah Health • South Jordan, UT • 5d ago

Hospital & Medical

Overview As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of coll...

5d ago

Go to Apply

Endoscopy Technician - (AEMT/RMA/CMA/NCMA)

University of Utah Health • South Jordan, UT • 6d ago

Hospital & Medical

6d ago

Go to Apply

Subscribe to get new jobs sent directly to you
(no charge, cancel anytime)

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.