Job Summary Bring your physician leadership, UM and Medical Director experience and commitment to quality to our Ohio health plan. You will provide guidance to staff, be responsible for day-to-day operations of the Medical Affairs department, and represent the plan at state regulatory agency meetings.
• Assists in recruitment, hiring and training of staff as needed.
• 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.
• Directs the team in providing physician leadership and expertise in the performance of prior authorization, inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities.
• Ensures that authorization decisions are rendered by qualified medical personnel, without hindrance due to fiscal or administrative incentives
• Doctorate Degree in Medicine
• Board Certified or eligible in a primary care specialty
• 10+ years relevant experience, including:
• 5+ years clinical practice
• 2 years previous experience as a Medical Director
• 3 years experience in Utilization/Quality Program management
• 2+ years HMO/Managed Care experience
• Current clinical knowledge
• Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen
• Knowledge of applicable state, federal and third party regulations
Required License, Certification, Association
• Current State Medical License without restrictions (free of sanctions from Medicaid or Medicare)
• Current Drug Enforcement Agency Certificate
Master's in Business Administration, Public Health, Healthcare Administration, etc.
• 12+ years relevant experience
• Peer Review, medical policy/procedure development, provider contracting experience.
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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