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Senior Specialist, Provider Contracts

Molina Healthcare Syracuse, NY
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Company: Molina Healthcare
Location: Syracuse, NY
Career Level: Director
Industries: Healthcare, Pharmaceutical, Biotech, Medical

Description

Job Summary Bring your physician leadership experience to our growing healthplan and not only perform utilization reviews, but affect population health in New York state. You will serve as the primary liaison between administration and medical staff and assure the ongoing development and implementation of policies and procedures that guide and support the provision of medical staff services. You will maintain a working knowledge of applicable national, state and local laws and regulatory requirements affecting the medical and allied health staff.

Knowledge/Skills/Abilities
• Facilitates conformance to regulatory requirements.
• Reviews quality referred issues, focused reviews and recommends corrective actions.
• Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency and continuity of care.
• Develops and implements medical policies.
• Conducts retrospective reviews of claims and appeals, and resolves grievances related to medical quality of care.

Job roles and responsibilities emphasize a team-based approach to care and support each member of the team being trained to meet the highest level of function allowed by state law.

Qualifications

Job Qualifications Required Education
Doctorate Degree in Medicine.

Required Experience
7-9 years

Required License, Certification, Association
NY State Medical license or ability to obtain one very quickly

Preferred Education
Graduate Degree or equivalent combination of education and experience

Preferred Experience
10+ years (5+ years as a Medical Director & 5+ years as a clinician)

Preferred License, Certification, Association
State Medical license

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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


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