Job Title

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 u2022 Leads a team of medical directors responsible for assessing appropriateness and medical necessity of health care services provided to plan members. u2022 Provides leadership and expertise in performance of prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT) activities. u2022 Recruits, hires, trains, mentors and develops medical director staff as needed. u2022 Ensures that authorization decisions are rendered by qualified medical personnel and without hindrance due to fiscal or administrative incentives. u2022 Analyzes data and identifies medical cost-savings and quality improvement opportunities. u2022 Accounts for regulatory and accreditation performance of assigned team and responds to inquiries, issues and complaints from government and accreditation regulators. u2022 Develops medical policies and procedures as needed. u2022 Conducts peer review processes. Required Qualifications u2022 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. u2022 At least 3 years management/leadership experience. u2022 Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state of practice. u2022 Board Certification. u2022 Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. u2022 Demonstrated ability to make strategic decisions. u2022 Knowledge of health care regulatory and legislative processes, including ability to read and interpret legislation. u2022 Experience gaining consensus, and collaborating in a highly matrixed organization. u2022 Experience demonstrating strong leadership, communication, consensus building, collaboration and financial acumen abilities. u2022 Evidence-based clinical criteria competency. u2022 Peer review, medical policy/procedure development, and provider contracting experience. u2022 Strong verbal and written communication skills. u2022 Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications u2022 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.