Senior Medical Director (Based in IA)

Molina Healthcare•Des Moines, IA

21d•$214,132 - $417,557

About The Position

Provides subject matter expertise and leadership for health plan or shared-services advanced clinical managed care and clinical performance. Uses specialty expertise, such as transplant or genetics, to support prior authorization, inpatient concurrent review, discharge planning, and clinical care management. May lead medical directors overseeing the appropriateness and medical necessity of services and ensuring members receive appropriate care in effective settings. Contributes to strategy for delivering quality, cost-effective member care.

Requirements

At least 10 years of relevant experience, including clinical practice experience, and at least 2 years as a medical director in a managed-care setting supporting utilization-management or quality-management initiatives, or an equivalent combination of relevant education and experience.
At least 5 years of management or leadership experience.
Doctor of Medicine (MD) or Doctor of Osteopathy (DO); active, unrestricted license in the state of practice.
Board certification.
Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff.
Demonstrated ability to make strategic decisions.
Knowledge of health care regulatory and legislative processes, including the ability to read and interpret legislation.
Business and financial acumen.
Competency in evidence-based clinical criteria.
Experience with peer review, medical policy and procedure development, and provider contracting.
Experience influencing stakeholders and gaining consensus.
Ability to work collaboratively across a highly matrixed organization.
Excellent verbal and written communication skills.
Proficiency with Microsoft Office and applicable software programs, and electronic medical records (EMR).

Nice To Haves

Certification such as Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA), or another health care or management certification.

Responsibilities

Leverage expertise to support advanced clinical performance in prior authorization, inpatient concurrent review, discharge planning, care management, and interdisciplinary care team activities.
Ensure authorization decisions are made by qualified medical personnel and are not hindered by fiscal or administrative incentives.
Analyze data and identify medical cost-saving and quality-improvement opportunities.
Account for regulatory and accreditation performance of the assigned team and respond to inquiries, issues, and complaints from government and accreditation regulators.
Develop medical policies and procedures as needed.
Conduct peer review processes.
May lead medical directors assessing the appropriateness and medical necessity of health care services provided to plan members.
As applicable, hire, train, develop, and manage the team, and demonstrate accountability for team performance and department-specific goals.
As applicable, develop and sustain a high-performance team focused on best-in-class solutions and attracting, developing, and retaining talent in support of strategy and long-term business objectives.