Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provision of medical staff services. Maintains a working knowledge of applicable national, state and local laws and regulatory requirements affecting the medical and allied health staff.
• 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.
• Doctorate Degree in Medicine
• Board Certified or eligible in a primary care specialty
• 7-9 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 to practice and free of sanctions from Medicaid or Medicare.
Master's in Business Administration, Public Health, Healthcare Administration, etc.
• 10+ 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.
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.