Medical Director

4 weeks ago

Jackson, Mississippi, United States Molina Healthcare Full time
Job Overview

Job Summary

Molina Healthcare seeks a highly skilled and experienced Medical Director to lead our medical staff and ensure the delivery of high-quality patient care. As a key member of our leadership team, you will be responsible for developing and implementing policies and procedures that guide and support the provision of medical staff services.

Key Responsibilities

  • Provide medical oversight and expertise in the development and implementation of utilization management programs and action plans.
  • Collaborate with network and group providers, medical managers, and other stakeholders to ensure a high quality of patient care and effective resource management.
  • Develop and implement clinical quality improvement activities, including NCQA-compliant QIA, to improve patient outcomes and reduce healthcare costs.
  • Facilitate conformance to Medicare, Medicaid, NCQA, and other regulatory requirements.
  • Review quality referred issues, focused reviews, and recommend corrective actions.
  • Conduct retrospective reviews of claims and appeals and resolve grievances related to medical quality of care.
  • Attend or chair committees as required, such as Credentialing, P&T, and others as directed by the Chief Medical Officer.
  • Monitor appropriate care and services through the continuum among hospitals, skilled nursing facilities, and home care to ensure quality, cost-efficiency, and continuity of care.
  • Ensure that medical decisions are rendered by qualified medical personnel, not influenced by fiscal or administrative management considerations, and that the care provided meets the standards for acceptable medical care.
  • Develop and implement plan medical policies.
  • Provide implementation support for Quality Improvement activities.
  • Stabilize, improve, and educate the Primary Care Physician and Specialty networks.
  • Foster Clinical Practice Guideline implementation and evidence-based medical practice.
  • Utilize IT and data analysts to produce tools to report, monitor, and improve Utilization Management.
  • Actively participate in regulatory, professional, and community activities.

Requirements

Education:

  • Doctorate Degree in Medicine.

Experience:

  • 3+ years relevant experience, including:
  • 2 years previous experience as a Medical Director in a clinical practice.
  • 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.

License, Certification, Association:

Current state (MS) Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.

Preferred Education:

Master's in Business Administration, Public Health, Healthcare Administration, etc.

Preferred Experience:

  • Peer Review, medical policy/procedure development, provider contracting experience.
  • Experience with NCQA, HEDIS, Medicaid, Medicare, and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
  • Experience in Utilization/Quality Program management.
  • HMO/Managed care experience.

Preferred License, Certification, Association:

Board Certification (OBGYN).

Physical Demands:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

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

Pay Range: $161,914.25 - $315,732.79 / ANNUAL

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