Medical director Jobs in Sterling Heights, MI

Job Opportunity

Leads and manages a team of medical directors delivering oversight and expertise in appropriateness and medical necessity of services provided to members - 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

• Leads a team of medical directors responsible for assessing appropriateness and medical necessity of health care services provided to plan members.
• Provides leadership and expertise in performance of prior authorization, inpatient concurrent review, discharge planning, care management and interdisciplinary care team (ICT) activities.
• Recruits, hires, trains, mentors and develops medical director staff as needed.
• 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.

Required Qualifications

Preferred Qualifications

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