Medical Director (Based in FL)

About the Role

Medical Director (Based in FL) at Molina Healthcare in United States. Benefits: health benefits.

Key Responsibilities

• Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization.
• Participates in and maintains the integrity of the appeals process, both internally and externally.
• Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care.
• Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process.
• Ensures medical protocols and rules of conduct for plan medical personnel are followed.
• Develops and implements plan medical policies.

Requirements

• Required Qualifications
• Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice (FL).
• Board certification In Pediatrics or Family Medicine.
• Ability to multi-task and meet deadlines.
• Experience with utilization/quality program management.
• Managed care experience.

Benefits & Compensation

• Determines appropriateness and medical necessity of health care services provided to plan members.
• Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity.
• At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience.
• Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs.
• Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V