Senior Medical Director (Medicare)

Molina Healthcare; Miami (FL); On-site; USD 214,000 - 418,000; Full time

Job summary

A prominent healthcare organization is seeking a Medical Director responsible for liaising between administration and medical staff. The ideal candidate will possess a Doctorate in Medicine and over 10 years of relevant experience, including clinical practice and HMO/Managed Care exposure. This role comes with a competitive salary range of $214,132 - $417,557 annually, along with a comprehensive benefits package.

Benefits

Competitive benefits and compensation package

Qualifications

• 10+ years relevant experience, including 5+ years of clinical practice.
• Demonstrated experience in Utilization/Quality Program management.
• Current State Medical License without restrictions.

Responsibilities

• Assist in recruitment, hiring and training of staff as needed.
• Analyze data for medical cost savings and quality improvement.
• Direct team in physician leadership and performance management.

Skills

Clinical practice

Utilization/Quality Program management

Leadership experience

Management and communication skills

Financial acumen

Knowledge of regulations

Education

Doctorate Degree in Medicine

Job description

Overview

JOB DESCRIPTION

Job Summary: Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provision of medical staff services. Maintains a working knowledge of applicable national, state and local laws and regulatory requirements affecting the medical and allied health staff.

Responsibilities

• Assists in recruitment, hiring and training of staff as needed.
• 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.
• Directs the team in providing physician leadership and expertise in the performance of prior authorization, inpatient concurrent review, discharge planning, case management and interdisciplinary care team activities.
• Ensures that authorization decisions are rendered by qualified medical personnel, without hindrance due to fiscal or administrative incentives
• Supervises and manages Medical Directors
• Develops medical policies and procedures
• Conducts peer review

Qualifications

REQUIRED EDUCATION:

• Doctorate Degree in Medicine
• Board Certified or eligible in a primary care specialty

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 10+ years relevant experience, including 5+ years of clinical practice and 3+ years HMO/Managed Care experience OR 5 years experience as a Molina Medical Director
• Demonstrated experience in Utilization/Quality Program management
• Previous leadership experience
• Peer review, medical policy/procedure development, and provider contracting experience
• Current clinical knowledge
• Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen
• Knowledge of applicable state, federal and third party regulations
• Peer review, medical policy/procedure development, and provider contracting experience.

Licenses & Certifications

• Current State Medical License without restrictions (free of sanctions from Medicaid or Medicare)
• Board Certification (Pediatrics, Family Practice, Ob/Gyn or Internal Medicine) is preferred

Preferred Education & Certification

• Master’s in Business Administration, Public Health, Healthcare Administration, etc. (preferred)
• Board Certification (Pediatrics, Family Practice, Ob/Gyn or Internal Medicine) (preferred)

Physical Demands

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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.