Sr Medical Director Clin Decis

Job Description
Job Summary
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.
  Knowledge/Skills/Abilities
• Improves quality and inter-rater reliability of clinical decisions.
• Ability to establish self as a credible subject matter expert while developing effective working relationships.
• Possesses outstanding communication skills, including the ability to foster a collaborative learning environment.
• Ability to manage conflict.
• Works to identify opportunities for improvement in clinical decision making.
• Assists in recruitment, hiring and training of staff as needed.
• Designs Medical Director training materials: onboarding materials and topic specific materials.
• Creates structure and program for Medical Director training for the health plans and for the central units.
• Creates structure and program for Medical Director auditing and testing for the health plans and for the central units.
• 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.
  Job Qualifications

Required Education
Doctorate Degree in Medicine
• Board Certified or eligible in a primary care specialty
Required Experience
10+ years' relevant experience, including:
• 5+ years' clinical practice
• 3+ years' HMO/managed care operations experience
• Previous supervisory experience
• Evidence based clinical criteria competency
• Peer review, medical policy/procedure development, and provider contracting experience
Required License, Certification, Association
• Active and unrestricted Current State Medical License without restrictions (free of sanctions from Medicaid or
Medicare)
Preferred Education
Master's in Business Administration, Public Health, Healthcare Administration, etc.
Preferred Experience
• 10+ years' experience in a management role leading clinicians
Preferred License, Certification, Association
Board Certification (Internal Medicine or Family Medicine).
 

 

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.