Medical Director, Utilization & Quality Strategy

Molina Healthcare; Kenosha (WI); On-site; USD 186,000 - 363,000; Full time

Job summary

Molina Healthcare in Wisconsin seeks a physician leader to oversee medical necessity determinations and utilization management, ensuring high-quality member care. This role collaborates with networks, medical managers, and leadership to implement evidence-based practices.

The position requires MD or DO licensure, board certification, and strong regulatory knowledge. Expect active participation in accreditation activities and quality improvement initiatives.

Qualifications

• Requires an MD or DO license in the practicing state.
• Board certification is required.
• Strong organizational and time-management skills.

Responsibilities

• Determines appropriateness and medical necessity of health care services.
• Supports utilization management programs and action plans for high-quality member care.
• Evaluates effectiveness of utilization management practices and monitors for over/under-utilization.
• Educates providers on utilization practices and resource management.
• Leads knowledge and implementation of medical necessity criteria.

Skills

Communication

Time management

Multi-tasking

Attention to detail

Critical thinking

Problem solving

Microsoft Office

Education

MD/DO degree

Board certification

Tools

Microsoft Office

Job description

Molina Healthcare in Wisconsin seeks a physician leader to oversee medical necessity determinations and utilization management, ensuring high-quality member care. This role collaborates with networks, medical managers, and leadership to implement evidence-based practices.

The position requires MD or DO licensure, board certification, and strong regulatory knowledge. Expect active participation in accreditation activities and quality improvement initiatives.