Chief Medical Officer, Product

Job Summary

Provides executive level strategy and leadership to a national business segment in the development and execution of care management, utilization management, and disease management programs. Develops clinical practice guidelines and oversees appropriateness and medical necessity of services provided to plan members. Partners with executive leadership team to provide cohesive direction towards company goals. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.

Essential Job Duties

• Provides executive strategy, vision and direction for the medical program for a designated Molina product.
• Leads analysis of medical care cost and utilization data.
• Leads and manages the development of techniques to effectively correct identified and anticipated utilization problems.
• Offers a positive leadership role in key segment / product medical management initiatives.
• Establishes and / or leads national programs / initiatives using clinical and industry best practices.
• Provides national best practice strategic direction and oversight for segment population management.
• Creates necessary cross-functional forums and uses data analysis to identify opportunities for medical cost trend and quality improvement.
• Leads development and implementation of national medical policy.
• Ensures compliance with medical policy and regulatory guidelines.
• Focuses on continual refinement of operational processes.
• Develops, performs and promotes interdepartmental integration and collaboration.
• Manages and evaluates team members in the performance of various clinical management activities.
• Ensures adequate staffing and service levels and maintains customer satisfaction.
• Collaborates with other functional areas that interface with the segment.
• Acts as a critical segment clinical leader for external providers and regulatory agencies.
• Identifies potential areas of non-compliance by overseeing audits.
• Collaborates with internal and external business partners to provide guidance and recommendations.
• Accountable for segment readiness for internal and external audits.
• Ensures department policies, procedures, and activities maintain adherence to regulations.
• Supports special / enterprise projects.

Required Qualifications

Preferred Qualifications

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 : $283,189.04 - $552,219 / ANNUAL