Medical Director - Utilization & Quality Improvement

Molina Healthcare; Bothell (WA); On-site; USD 180,000 - 230,000; Full time

Job summary

Molina Healthcare in Washington state seeks a Medical Director to oversee appropriateness and medical necessity of services for members, improving quality and cost-effectiveness. You’ll lead utilization management, guide NCQA/URAC readiness, and collaborate with providers and clinical leadership to ensure compliant, evidence-based care.

Requires MD/DO license, board certification, and 3+ years in health care with medical practice experience; strong leadership, regulatory knowledge, and

Qualifications

• Requires MD or DO degree and board certification.
• Active unrestricted license in WA.
• Experience with utilization/quality program management is preferred.

Responsibilities

• Determines appropriateness and medical necessity of health care services for plan members.
• Supports utilization management programs and action plans.
• Educates providers and medical managers on utilization practices.
• Leads in NCQA and URAC readiness and quality improvement activities.
• Reviews appeals and adverse events related to care quality.

Skills

Healthcare experience

MD/DO license

Board certification

Regulatory knowledge

Cross-functional collaboration

Organizational skills

Time management

Multitasking

Attention to detail

Critical thinking

Communication skills

MS Office proficiency

Education

MD or DO degree

Tools

MS Office

Job description

Molina Healthcare in Washington state seeks a Medical Director to oversee appropriateness and medical necessity of services for members, improving quality and cost-effectiveness. You’ll lead utilization management, guide NCQA/URAC readiness, and collaborate with providers and clinical leadership to ensure compliant, evidence-based care.

Requires MD/DO license, board certification, and 3+ years in health care with medical practice experience; strong leadership, regulatory knowledge, and