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Sr Medical Director, Health Plan (Remote in KY)

Passport Health Plan by Molina Healthcare Louisville, Kentucky; Lexington-Fayette, Kentucky Job ID 2013900
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Passport 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
  • passport-logo

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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

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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

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Responsibilities

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.

KNOWLEDGE/SKILLS/ABILITIES

This Sr. Medical Director role is authorized for use in the State Health Plans. This is a manager role and supervises other Medical Directors in their State Health Plan. In order to be eligible to use this job, this role must be supervising a minimum of five Medical Directors.

  • 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.

JOB QUALIFICATIONS

Required Education

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

Required Experience

  • 10+ 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 (free of sanctions from Medicaid or Medicare)
  • 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.

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

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: 05/12/2022

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