Senior Medical Director, Clinical Performance & Utilization

Molina Healthcare, Inc.; Des Moines (IA); On-site; USD 230,000 - 320,000; Full time

Job summary

Molina Healthcare, Inc. in Des Moines, IA seeks an experienced medical director to provide leadership for advanced clinical managed care.

You will oversee prior authorization, inpatient reviews, discharge planning and care management, leveraging specialty expertise to ensure quality, cost-effective member care. Ideal candidates hold an MD or DO with board certification, at least 10 years of clinical experience and 5 years in management, and can navigate regulatory requirements while guiding a

Qualifications

• MD or DO with active license in practice state.
• Board certification in relevant field.
• Extensive leadership in managed care settings.

Responsibilities

• Leads advanced clinical performance for prior authorization, inpatient review, discharge planning and ICT activities.
• Ensures authorizations are made by qualified medical personnel without undue incentives.
• Analyzes data to identify cost-savings and quality improvements.
• Handles regulatory inquiries and responds to government regulators.
• Develops medical policies and conducts peer review.
• May lead medical directors assessing appropriateness and medical necessity.
• Hires, trains, and manages team to meet department goals.
• Builds a high-performance team aligned with strategic objectives.

Skills

Leadership

Strategic decisions

Regulatory knowledge

Communication skills

Financial acumen

Education

MD/DO

Board Certification

Tools

EMR systems

Microsoft Office

Job description

Molina Healthcare, Inc. in Des Moines, IA seeks an experienced medical director to provide leadership for advanced clinical managed care.

You will oversee prior authorization, inpatient reviews, discharge planning and care management, leveraging specialty expertise to ensure quality, cost-effective member care. Ideal candidates hold an MD or DO with board certification, at least 10 years of clinical experience and 5 years in management, and can navigate regulatory requirements while guiding a