Senior Medical Director

Molina Healthcare • Saint Petersburg, FL • 10h 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 • Tampa, FL • 11h ago

Hospital & Medical

11h ago

Go to Apply

Physician (Critical Care)

Veterans Affairs, Veterans Health Administration • Bay Pines, FL • 23h ago

Hospital & Medical

Summary The Bay Pines VA Healthcare System is seeking experienced Surgical Intensivist. The Surgical Intensivist takes a comprehensive approach to caring for patients. Primary responsibility is for patient care while lea...

23h ago

Go to Apply

Physician (Dermatology)

Veterans Affairs, Veterans Health Administration • Bay Pines, FL • 23h ago

Hospital & Medical

Summary This position is in the Medicine Service at the C.W. Bill Young VA Medical Center. The duties and responsibilities are carried out throughout the medical center including all clinical and patient care areas invol...

23h ago

Go to Apply

Medical Supply Technician (Sterile Processing)

Veterans Affairs, Veterans Health Administration • Bay Pines, FL • 23h ago

Hospital & Medical

Summary The Medical Supply Technician (MST) works within the Sterile Processing Service Line at the C.W. Bill Young VA Medical Center, Bay Pines VA Healthcare System in Bay Pines FL. In this position, the MST will provid...

23h ago

Go to Apply

Medical Receptionist - Patient Service Specialist

Select Medical • Apollo Beach, FL • 1d ago

Hospital & Medical

Overview Position: Medical Receptionist -Patient Service Specialist Location: 232 Harbor Village Lane, Apollo Beach, FL 33572 Type of Employment: Full-time Schedule: Monday-Friday; Schedule TBD Compensation: $15.00-$18.0...

1d ago

Go to Apply

Inhouse Counsel/Manager Legal, Compliance & Risk Management/Outpatient Clinics/Full-time Employment

Harmony United Psychiatric Care • Clearwater, FL • 1d ago

Hospital & Medical

Company: Harmony United Psychiatric Care Job Title: Inhouse Counsel / Manager Legal, Compliance & Risk Management / Outpatient Clinics / Full-time Employment / Clearwater About Us Harmony United Psychiatric Care is p...

1d ago

Go to Apply

100% Remote Pharmacy Technician

Actalent • Tampa, FL • 1d ago

Hospital & Medical

Join Our Team! We're looking for Pharmacy Technicians who are detail-oriented, customer-focused, and ready to make an impact in a fast-paced call center environment. If you thrive on helping patients and providers while...

1d ago

Go to Apply

Patient Engagement Representative

UnitedHealth Group • Tampa, FL • 2d ago

Hospital & Medical

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Opportunities with Genoa Healthcare. A career with Genoa Healthcare means...

2d ago

Go to Apply

Medical Technologist PRN

HCA Healthcare • Saint Petersburg, FL • 2d ago

Hospital & Medical

Description Introduction Last year our HCA Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) Medical Technologist PRN with HCA Florida Northside Hospital you can be a part of an...

2d ago

Go to Apply

Registered Nurse- Community Living Center and Hospice

Veterans Affairs, Veterans Health Administration • Bay Pines, FL • 3d ago

Hospital & Medical

Summary Responsible and accountable for all elements of the nursing process when providing and/or supervising direct patient care. Assesses, plans, implements, and evaluates care based on age specific components. Assumes...

3d 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.