Senior Medical Director

Molina Healthcare • Davenport, IA • 2h 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

Medical Assistant (MA): Orthopedic Care

Trinity Health • Bettendorf, IA • 1d ago

Hospital & Medical

Employment Type: Full time Shift: Day Shift Description: Medical Assistant Location: Orthopedic Care Davenport, IA Schedule: Dayshift, Monday through Friday, 7:30 am to 5:00 pm General Requirements: Field Of Study: Medic...

1d ago

Go to Apply

Medical Assistant (MA): Orthopedic Care

Trinity Health • Bettendorf, IA • 1d ago

Hospital & Medical

1d ago

Go to Apply

Medical Assistant (MA): Specialty Float

Trinity Health • Davenport, IA • 1d ago

Hospital & Medical

Employment Type: Full time Shift: Day Shift Description: Medical Assistant Location: All MercyOne Genesis Specialty Clinics Schedule: Dayshift, Monday through Friday, 8 am to 5 pm General Requirements: Field Of Study: Me...

1d ago

Go to Apply

Medical Assistant (MA): Orthopedic Care

Trinity Health • Bettendorf, IA • 1d ago

Hospital & Medical

1d ago

Go to Apply

Medical Assistant (MA): Orthopedic Care

Trinity Health • Bettendorf, IA • 1d ago

Hospital & Medical

1d ago

Go to Apply

Pharmacy Manager - Community

UnitedHealth Group • Moline, IL • 1d ago

Hospital & Medical

$20,000 Sign On Bonus for External Candidates Opportunities with Genoa Healthcare . A career with Genoa Healthcare means you're part of a collaborative effort to serve behavioral health and addiction treatment communitie...

1d ago

Go to Apply

Pharmacy Manager - Community

UnitedHealth Group • Davenport, IA • 1d ago

Hospital & Medical

1d ago

Go to Apply

Pharmacy Manager - Community

UnitedHealth Group • Bettendorf, IA • 1d ago

Hospital & Medical

1d ago

Go to Apply

Pharmacy Manager - Community

UnitedHealth Group • Rock Island, IL • 1d ago

Hospital & Medical

1d ago

Go to Apply

Medical Support Assistant

Veterans Affairs, Veterans Health Administration • Davenport, IA • 2d ago

Hospital & Medical

Summary The Medical Support Assistant (MSA) serves in the Primary Care Service Line with the Iowa City VA Health Care System at the Quad Cities VA Clinic. The incumbent performs duties related to the receipt, intake, and...

2d 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.