Senior Medical Director (Medicare)

Molina Healthcare; Omaha (NE); On-site; USD 214,000 - 418,000; Full time

Job summary

A healthcare provider in Omaha seeks an experienced Medical Director to oversee medical staff services. The ideal candidate will have a Doctorate in Medicine, extensive clinical practice experience, and proven leadership skills. Responsibilities include directing physician leadership, developing medical policies, and ensuring compliance with regulations. This role offers a competitive salary and benefits package.

Benefits

Competitive benefits and compensation package

Qualifications

• 10+ years relevant experience including 5+ years of clinical practice.
• 3+ years of HMO/Managed Care experience.
• Experience in peer review and medical policy/procedure development.

Responsibilities

• Serve as the primary liaison between administration and medical staff.
• Assist in recruitment, hiring and training of staff.
• Direct the team in providing physician leadership.

Skills

Utilization/Quality Program Management

Leadership

Clinical knowledge

Strong Management and Communication Skills

Consensus Building

Financial Acumen

Education

Doctorate Degree in Medicine

Master's in Business Administration or related field

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.

Job Duties

• 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

Job 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 acument
• Knowledge of applicable state, federal and third party regulations
• Peer review, medical policy/procedure development, and provider contracting experience.

Required License, Certification, Association

Current State Medical License without restrictions (free of sanctions from Medicaid or Medicare)

Preferred Education

Master’s in Business Administration, Public Health, Healthcare Administration, etc.

Preferred License, Certification, Association

Board Certification (Pediatrics, Family Practice, Ob/Gyn or Internal Medicine).

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.

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.