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. Essential Job Duties • 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. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. 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.