Chief Medical Officer, Health Plan (Must reside in Kentucky)
Passport Health Plan by Molina Healthcare Louisville, Kentucky Job ID 2025032Passport Health Plan by Molina Healthcare has a mission to provide quality health care to those who need it, no matter their circumstances. Today, Molina health plans serve 3,331,000 members across the country through government-funded programs. Each day, we work to earn the trust our partners and members put in us, so they can lean on Molina. Together, Passport Health Plan and Molina share a commitment to improving the health and quality of life of our members across the Commonwealth of Kentucky.
- Full Time, Part Time
- Level: All Levels
- Travel: Occassional
Success Profile
What makes you successful at Passport Health Plan by Molina Healthcare? Check out the traits we’re looking for and see if you're the right fit!
- Compassionate
- Consultive
- Patient
- Problem-Solver
- Sincere
- Relationship Expertise
Benefits
-
Insurance
Medical · Dental · Vision
Group & Voluntary Life Insurance
Aflac · Pet Health · Identity Theft
Auto & Home Insurance -
Savings
Flexible Spending Accounts
401K · Roth 401K
Employee Stock Purchase Plan -
Career Growth
Continuing Education Units
Education Reimbursement -
Time Off
Paid Time Off
Volunteer Time Off
Company Holidays -
Additional Perks
Legal Assistance Plan
Employee Assistance & Well Being Programs
Employee Perks Platform
Rideshare Portal
Responsibilities
Job Description
Must reside in Kentucky, and possess an active Kentucky license.
Job Summary
The Health Plan Chief Medical Officer provides leadership in the development and execution of the Plan’s disease management, case management, utilization management, and care management programs. Oversees the development of the Plan’s clinical practice guidelines and provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to Plan members, targeting improvements in efficiency and satisfaction for members and providers.
KNOWLEDGE/SKILLS/ABILITIES
- Provides leadership to the health plan in the areas of strategic planning, strategy execution and implementation of care management programs, including such programs as Quality Improvement, Utilization Management, Care Management, Predictive Modeling, and Disease Management.
- Leads the health plan's analysis of medical care cost and utilization data. Leads and manages the development of techniques to effectively correct identified and anticipated utilization problems while assuring that our members receive the care they need.
- Provides leadership, direction and oversight functions to the health plan's medical management staff designed to achieve best in class performance as defined by identified metrics.
- Offers a positive leadership role in key health plan medical management initiatives aimed at optimizing utilization of medical resources.
- Oversees and directs the rendering of medical management decisions at all levels of the health plan that maximize benefits for our members while pursuing and supporting corporate objectives.
JOB QUALIFICATIONS
Required Education
- Doctorate Degree in Medicine
- Board Certified or eligible in a primary care specialty
Required Experience
- 10+ years relevant experience, including:
- Minimum 5 years clinical practice.
- 5 years in a Medical Director role.
- 4 years HMO/Managed Care experience, including Utilization and/or Quality Program management.
- 5 years managed care administrative experience to include NCQA or URAC
Required License, Certification, Association
- Active and unrestricted Current State Medical License without restrictions (free of sanctions from Medicaid or Medicare)
- Active and unrestricted current Drug Enforcement Agency Certificate
Preferred Education
Master’s in business administration, Public Health, Healthcare Administration, etc.
Preferred Experience
- 12+ years relevant experience
- Peer Review, medical policy/procedure development, provider contracting experience.
- Preferred License, Certification, Association
- Active and unrestricted Board Certification (Pediatrics, Family Practice, Ob/Gyn or Internal Medicine).
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: $246,251.34 - $480,190.11 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
About Us
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Job Type: Full Time Posting Date: 03/14/2024ABOUT OUR LOCATION
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