Medical Director (NV)

Molina Healthcare is seeking a Medical Director to oversee medical quality, efficiency, and satisfaction among member services. This role involves determining appropriateness of services, supporting utilization management programs, and participating in national committees and clinical initiatives. It requires strong leadership, collaboration, and analytical skills.

Requirements

• Determines appropriateness and medical necessity of health care services.
• Supports utilization management program and action plans.
• Evaluates the effectiveness of utilization management practices.
• Participates in NCQA/URAC certification processes.
• Conducts retrospective reviews of claims and appeals.
• Develops and implements plan medical policies.

Benefits

• Competitive benefits and compensation package
• Equal Opportunity Employer