Medical Director: Quality & Utilization Leader

Molina Healthcare; Detroit (MI); On-site; USD 210,000 - 320,000; Full time

Job summary

Molina Healthcare seeks a physician leader to provide medical oversight for appropriateness and medical necessity of services to plan members in Michigan. You will support utilization management, educate providers, and participate in accreditation readiness to ensure high-quality, cost-effective care.

The role requires MD/DO with board certification, strong cross-functional collaboration, and experience in regulated healthcare environments. On-site position located in Detroit, MI.

Qualifications

• At least 3 years health care experience, including 2 years in medical practice.
• MD or DO licensed in MI.
• Board certification required.
• Knowledge of national, state, and local medical regulations.
• Ability to work cross-collaboratively in a matrixed organization.
• Strong organizational and time-management skills.
• Attention to detail and problem-solving ability.
• Strong verbal and written communication skills.
• Proficiency with Microsoft Office and related software.

Responsibilities

• Determine appropriateness and medical necessity of care for plan members.
• Support utilization management programs and action plans for high-quality care.
• Evaluate effectiveness of UM practices and monitor utilization.
• Educate providers on utilization practices and guideline application.
• Lead and supervise use of medical necessity criteria.
• Participate in appeals and ensure quality of care investigations.
• Contribute to NCQA and URAC accreditation preparation.

Skills

Health care experience

Medical practice experience

Cross-functional collaboration

Time management

Attention to detail

Communication skills

Microsoft Office

Education

MD or DO license

Board certification

Tools

Microsoft Office

Job description

Molina Healthcare seeks a physician leader to provide medical oversight for appropriateness and medical necessity of services to plan members in Michigan. You will support utilization management, educate providers, and participate in accreditation readiness to ensure high-quality, cost-effective care.

The role requires MD/DO with board certification, strong cross-functional collaboration, and experience in regulated healthcare environments. On-site position located in Detroit, MI.