Senior Medical Director (Based in IA)

Molina Healthcare; Des Moines (IA); On-site; USD 214,000 - 418,000; Full time

Job summary

Molina Healthcare is seeking a senior clinical leader in Des Moines to drive advanced performance across prior authorization, inpatient review, discharge planning, and care management. The role leads medical directors and ensures high-quality, cost-efficient member care.

Candidates should have MD/DO with board certification, 10+ years in care delivery, and strong leadership and collaboration skills to navigate a matrixed environment. Competitive benefits offered.

Qualifications

• At least 10 years of relevant experience including clinical practice and 2+ years as medical director.
• At least 5 years of management/leadership experience.
• Active MD/DO license in state of practice with board certification.
• Working knowledge of health care regulatory requirements.
• Ability to make strategic decisions and read regulations.
• Business and financial acumen in managed care settings.
• Evidence-based clinical criteria competency and peer review experience.
• Experience influencing stakeholders and achieving consensus.
• Ability to work cross-collaboratively in a matrixed organization.
• Excellent verbal and written communication skills.
• Proficiency with MS Office and EMR systems.

Responsibilities

• Provide leadership for advanced clinical performance in authorization, review, discharge planning, and care management.
• Ensure authorship decisions by qualified medical personnel without undue incentives.
• Analyze data to identify cost savings and quality improvements.
• Monitor regulatory and accreditation performance and address inquiries.
• Develop medical policies and procedures as needed.
• Lead peer review processes and clinical policy development.

Skills

Leadership

Strategic decisions

Communication skills

Stakeholder consensus

Regulatory knowledge

Financial acumen

Education

MD/DO degree

Board Certification

Tools

Microsoft Office

EMR proficiency

Job description

JOB DESCRIPTION Job Summary

Provides deep subject matter expertise and leadership for health plan or shared services advanced clinical managed care/clinical performance. Leverages specialty expertise (transplant, genetics, etc.) to support prior authorization, inpatient concurrent review, discharge planning, and clinical care management activities. May lead a team of medical directors - delivering oversight and expertise in appropriateness and medical necessity of services provided to members, and ensuring members receive the most appropriate care in the most effective setting. Contributes to overarching strategy to provide quality and cost-effective member care.

• Leverages expertise to deliver advanced clinical performance for prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT) activities.
• Ensures that authorization decisions are rendered by qualified medical personnel and without hindrance due to fiscal or administrative incentives.
• 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.
• Develops medical policies and procedures as needed.
• Conducts peer review processes.
• May lead a team of medical directors responsible for assessing appropriateness and medical necessity of health care services provided to plan members.
• As applicable, hires, trains, develops and manages team demonstrates accountability for team performance and achievement of department-specific goals.
• As applicable, develops and sustains a high-performance team, dedicated to best-in-class solutions responsible for attracting, developing and retaining top-tier talent to support strategy and long-term business objectives.

Required Qualifications

• At least 10 years of relevant experience, including clinical practice experience, and at least 2 years as a medical director in managed care setting supporting utilization management/quality management initiatives, or equivalent combination of relevant education and experience.
• At least 5 years of management/leadership experience.
• Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in 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 ability to read and interpret legislation.
• Business and financial acumen.
• Evidence-based clinical criteria competency.
• Peer review, medical policy/procedure development, and provider contracting experience.
• Experience influencing and gaining consensus across stakeholders.
• Ability to work cross-collaboratively in a highly matrixed organization.
• Excellent verbal and written communication skills.
• Microsoft Office suite/applicable software program(s) proficiency, and electronic medical record (EMR) proficiency.

Preferred Qualifications

• 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 other health care or management certification.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $214,132 - $417,557 / ANNUAL

• Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.