We are seeking an experienced Pediatric Medical Director to contribute within our Utilization Review / Medical Affairs team who shares a passion for working with the undeserved population for our Washington Health Plan. Would love to hear from you if you have interest, or if you know of someone that may be interested! This position can be REMOTE and we can consider candidates out of state, however must obtain a WASHINGTON MD license.
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.
Knowledge/Skills/Abilities • Facilitates conformance to regulatory requirements. • Reviews quality referred issues, focused reviews and recommends corrective actions. • Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency and continuity of care. • Develops and implements medical policies. • Conducts retrospective reviews of claims and appeals, and resolves grievances related to medical quality of care.
Job roles and responsibilities emphasize a team-based approach to care and support each member of the team being trained to meet the highest level of function allowed by state law.
Job Qualifications Required Education • Doctorate Degree in Medicine • Board Certified or eligible in a primary care specialty
Required Experience • 7-9 years relevant experience, including: • 5+ years clinical practice • 2 years previous experience as a Medical Director • 3 years experience in Utilization/Quality Program management • 2+ years HMO/Managed Care 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
Required License, Certification, Association • Current state Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
Preferred Education Master's in Business Administration, Public Health, Healthcare Administration, etc.
Preferred Experience • 10+ years relevant experience • Peer Review, medical policy/procedure development, provider contracting experience.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Molina Healthcare was founded in 1980 as a single community clinic in Long Beach, California. The goal was to create a future where everyone receives quality health care, and it is because of the dedication of our employees that we have been able to further this mission. Today, Molina Healthcare is ranked number 156 on the FORTUNE 500 list and serves millions of individuals receiving government as...sistance across the country. If you desire to work with a purpose-driven organization, have a passion for helping those who are most in need, and are seeking a company that will invest in and promote the advancement of your career, then look no further than Molina Healthcare.