Interim Director jobs at HealthTrust - 54 jobs

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and 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 * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. •Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse incidents and quality of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. * Reviews quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. * Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. * Ensures medical protocols and rules of conduct for plan medical personnel are followed. * Develops and implements plan medical policies. * Provides implementation support for quality improvement activities. * Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. * Actively participates in regulatory, professional and community activities. Required Qualifications * At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. * Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. * Board certification. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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 #PJHS #LI-AC1 Pay Range: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and 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 * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. •Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse incidents and quality of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. * Reviews quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. * Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. * Ensures medical protocols and rules of conduct for plan medical personnel are followed. * Develops and implements plan medical policies. * Provides implementation support for quality improvement activities. * Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. * Actively participates in regulatory, professional and community activities. Required Qualifications * At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. * Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. * Board certification. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Responsibilities Windsor Laurelwood Center is seeking a talented and dynamic Director of Intake and Assessment to join our team of dedicated healthcare professionals! For over 100 years, Windsor Laurelwood has provided high-quality behavioral health and substance abuse treatment services to adults, adolescents, and children. Our multidisciplinary treatment team includes board-certified psychiatrists, psychologists, registered nurses, licensed social workers, case managers, milieu and activity therapists. Our patients bring with them manv different clinical challenges and high acuity illnesses that require specific and individualized care. We balance our busy work environment with a strong commitment to teamwork that makes Windsor Laurelwood a challenging, yet fun place to work. While taking care of our patients, we also strive to take care of each other. Our hospital has a strong, seasoned leadership team, with mentoring and coaching opportunities available to professionals interested in growing their career in the mental health industry. Position Summary: The Director of Intake and Assessment is accountable for directing the Assessment and Referral activities at the facility. This position provides direction to staff of Assessment and Referral Counselors in the provision of psychiatric assessment services, including clinical evaluations, crisis intervention and referrals. This position interfaces closely with the medical staff, other department heads and administration, treatment team, external case managers, managed care organizations and functions as a liaison with other hospital departments. Qualifications Job Duties/Responsibilities: * Directs the screening of potential patients for admission into the program and initiate the integrated assessment process. * Assists administration, physicians and clinical staff in the assessment of pending admits to determine appropriateness of level of care and communicates pending admissions to the Nursing Department. * Uses the approved admission criteria and make decisions concerning the level of care for treatment using the least restrictive level appropriate. The plan for episode of care is initiated at admission to all levels of care. * Monitors all intake/reservation information calls during normal business hours and prepares appropriate internal 1371 forms. * Functions as a liaison between physicians and families, coordinates with transportation services and other mental health facilities to organize the admission procedures. * Plans, coordinates and evaluates direct and indirect facility assessments and patient admissions. * Ensures that all vital patient assessment information is referred accurately to the attending physicians, and that patient historical information obtained is complete to facilitate an accurate determination for the appropriate level of care. * Communicates with external reviewers and referral sources through implementation of the R.A.P process and conduct all required external reviews and maintain documentation of all such interaction. * Ensures that third-party payors are notified of, or participate in, decisions about appropriate transitions between levels of care. * Coordinates activities to provide the community with resources and referrals. * Prepares monthly statistics for the marketing and administrative departments. * Prepares morning meeting reports to communicate pertinent census information, referral sources, pending admissions and follow-up action pending admissions, pending discharges and nature of discharge. * Coordinates with PAT assessments of all patients who are potential involuntary admissions. * Provides guidance to community resources available to person inappropriate or unavailable for admission but who are requiring further guidance and referrals. * Maintains records of temporary privileges for all physicians, psychiatrists, psychologists, and allied health professionals and coordinates staffing privileges with Medical Staff Coordinator and Medical Director. Professional Collaboration: * Provides services to current referral sources to assure their satisfaction and continued associations. * Allocates and coordinate program resources for marketing and referral development activities. * Provides education, support and recognition to staff participating in referral development activities. * Collaborates with the Director of Business Development to develop, implement and monitor a target marketing plan for the program. * Provides for guest relations and ensure the appearance of the facility and manner in which program staff communicate with patients, families, referral sources and fellow staff is effective and professional. * Ensures the implementation of an ongoing system of program orientation for patients, families and professionals and others. Leadership: * Engage and Inspire - Create an environment in which people do their best work * Build Talent - Utilize established interviewing and selection processes to select the right people for the right job and the right time. * Coach and Develop Others - Utilize a systematic approach to coaching which includes setting goals and expectations; creating a learning environment and providing continuous feedback. * Manage Conflict - Address and resolve conflict directly and constructively * Functional Knowledge - Proficient in specialized technical knowledge of discipline / specialty area; demonstrate knowledge of Joint Commission standards and other related regulatory and/or quality agencies. * Quality and Process Improvement - Focus on quality, patient/employee safety and error reduction; applies best practices by continuously improving services, methods or approaches. * Manage Resources - Actively utilize functional resources (internal and external agencies, UHS, etc.) in developing creative solutions to address problems * Manage Change -Respond to new regulations, changing economic conditions, hospital staffing, external environment, etc. * Communication and Relationship Building - Effectively communicate at all levels; able to build credibility with professionals, physicians, healthcare professionals and constituents within the community. * Other duties as assigned Benefit Highlights: * Challenging and rewarding work environment * Competitive Compensation * Excellent Medical, Dental, Vision and Prescription Drug Plans * 401(K) with company match and discounted stock plan * SoFi Student Loan Refinancing Program * Career development opportunities within UHS and its 300+ Subsidiaries Education: Master's Degree from an accredited college or university in social work, psychology, counseling, mental health, nursing, or related field. Experience: A minimum of five (5) years direct clinical experience in a psychiatric or mental health setting desirable. Working knowledge of the mental health field and experience in clinical interviewing, patient assessment, family treatment, treatment planning, communicating with external review organizations or comparable entities and working effectively with people of diverse backgrounds. Licensure: RN, PCC, LISW or other applicable license is preferred. Additional Requirements: Trained in non-violent crisis intervention training and CPR prior to accepting independent assignment or released from orientation. One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. has built an impressive record of achievement and performance. Growing steadily since its inception into an esteemed Fortune 500 corporation, annual revenues were $11.6 billion in 2020. In 2021, UHS was again recognized as one of the World's Most Admired Companies by Fortune; in 2020, ranked #281 on the Fortune 500; and listed #330 in Forbes ranking of U.S.' Largest Public Companies. Headquartered in King of Prussia, PA, UHS has 89,000 employees and through its subsidiaries operates 26 acute care hospitals, 334 behavioral health facilities, 39 outpatient facilities and ambulatory care access points, an insurance offering, a physician network and various related services located in 38 U.S. states, Washington, D.C., Puerto Rico and the United Kingdom.

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and 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 * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. •Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse incidents and quality of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. * Reviews quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. * Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. * Ensures medical protocols and rules of conduct for plan medical personnel are followed. * Develops and implements plan medical policies. * Provides implementation support for quality improvement activities. * Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. * Actively participates in regulatory, professional and community activities. Required Qualifications * At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. * Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. * Board certification. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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 #PJHS #LI-AC1 Pay Range: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and 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 * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. •Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse incidents and quality of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. * Reviews quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. * Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. * Ensures medical protocols and rules of conduct for plan medical personnel are followed. * Develops and implements plan medical policies. * Provides implementation support for quality improvement activities. * Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. * Actively participates in regulatory, professional and community activities. Required Qualifications * At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. * Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. * Board certification. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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 DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs. * Facilitates behavioral health-related regional medical necessity reviews and cross coverage. * Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses. * Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment. * Provides second level behavioral health clinical reviews, peer reviews and appeals. * Supports behavioral health committees for quality compliance. * Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. * Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the recruitment and orientation of new psychiatric medical directors. * Ensures all behavioral health programs and policies are in line with industry standards and best practices. * Assists with new program implementation and supports for health plan in-source behavioral health services. Required Qualifications * At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience. * Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state (NY) of practice. * Board Certification in Psychiatry. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and 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 * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. •Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse incidents and quality of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. * Reviews quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. * Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. * Ensures medical protocols and rules of conduct for plan medical personnel are followed. * Develops and implements plan medical policies. * Provides implementation support for quality improvement activities. * Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. * Actively participates in regulatory, professional and community activities. Required Qualifications * At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. * Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. * Board certification. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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 #PJHS #LI-AC1 Pay Range: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and 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 * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. •Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse incidents and quality of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. * Reviews quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. * Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. * Ensures medical protocols and rules of conduct for plan medical personnel are followed. * Develops and implements plan medical policies. * Provides implementation support for quality improvement activities. * Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. * Actively participates in regulatory, professional and community activities. Required Qualifications * At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. * Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. * Board certification. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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 DESCRIPTION Job SummaryProvides medical oversight and expertise related to behavioral health and chemical dependency services, and assists with implementation of integrated behavioral health care programs within specific markets/regions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties * Provides behavioral health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical dependency services - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and decrease costs. * Facilitates behavioral health-related regional medical necessity reviews and cross coverage. * Standardizes behavioral health-related utilization management, quality, and financial goals across all lines of businesses. * Responds to behavioral health-related requests for proposal (RFP) sections and reviews behavioral health portions of state contracts. * Assists behavioral health medical director lead trainers in the development of enterprise-wide education on psychiatric diagnoses and treatment. * Provides second level behavioral health clinical reviews, peer reviews and appeals. * Supports behavioral health committees for quality compliance. * Implements behavioral health specific clinical practice guidelines and medical necessity review criteria. * Tracks all clinical programs for behavioral health quality compliance with National Committee for Quality Assurance (NCQA) and Centers for Medicare and Medicaid Services (CMS). * Assists with the recruitment and orientation of new psychiatric medical directors. * Ensures all behavioral health programs and policies are in line with industry standards and best practices. * Assists with new program implementation and supports for health plan in-source behavioral health services. Required Qualifications * At least 3 of relevant experience, including 2 years of medical practice experience in psychiatry/behavioral health, or equivalent combination of relevant education and experience. * Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and unrestricted in state (NY) of practice. * Board Certification in Psychiatry. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and 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 * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. •Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse incidents and quality of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. * Reviews quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. * Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. * Ensures medical protocols and rules of conduct for plan medical personnel are followed. * Develops and implements plan medical policies. * Provides implementation support for quality improvement activities. * Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. * Actively participates in regulatory, professional and community activities. Required Qualifications * At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. * Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. * Board certification. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and 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 * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. •Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse incidents and quality of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. * Reviews quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. * Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. * Ensures medical protocols and rules of conduct for plan medical personnel are followed. * Develops and implements plan medical policies. * Provides implementation support for quality improvement activities. * Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. * Actively participates in regulatory, professional and community activities. Required Qualifications * At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. * Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. * Board certification. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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 #PJHS #LI-AC1 Pay Range: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Miami Valley Hospitalist Group Full-time/ 80 hours per pay General Summary/Responsibilities: The Associate Program Medical Director role is vital to the success of the Hospitalist Group Practice. She/he works closely with the PMD and operational staff to; enhance day-today clinical operations, achieving group quality metrics, coordinating continuing education opportunities, orientation of new physicians, to enhance the network's delivery of quality patient care and meet legal compliance. This position is also responsible for providing clinical management to a team of patients while assisting with administrative duties. Associate Program Director may work Monday through Friday or maintain 7 on 7 off schedule to facilitate working with both teams. Together, the Program Medical Director, the Associate Program Medical Director and Practice Administrator are responsible for the performance of the hospitalist team and its specific goals. Reporting Structure The Associate Program Medical Director reports to the Program Medical Director. Qualifications * Previous leadership and management skills in a clinical environment * Knowledge of physician services documentation and coding compliance requirements * Skill in physician recruitment and retention practices * Experience in quality improvement initiatives, preferably with leadership responsibilities * Master of health administration (MHA) or Master of business administration (MBA) preferred. Education Minimum Level of Education Required: Medical Doctorate degree Additional requirements: * Type of degree: MD or DO degree * Area of study or major: Medicine * Preferred educational qualifications: Master of health administration (MHA) or Master of business administration (MBA) preferred. * Position specific testing requirement: N/A Licensure/Certification/Registration * Current certification in Hospital Medicine, Internal Medicine or Family Practice by respective allopathic or osteopathic boards * License to practice in the state of Ohio * Experience in hospital medicine * Minimum 3 years clinical experience Experience Minimum Level of Experience Required: Choose an item. Prior job title or occupational experience: Enter prior experience or N/A Prior specific functional responsibilities: Enter prior functional responsibilities or N/A Preferred experience: Enter preferred experience or N/A Other experience requirements: Enter other experience requirement or N/A Knowledge/Skills * Excellent leadership skills to inspire excellence and ensure a shared vision * Dedicated to meeting the expectations and requirements of internal and external customers. * Ability to maintain confidentiality regarding operational and individual situations. * Positively, efficiently, and effectively manage change. * Strong interpersonal communications skills (written and verbal) across disciplines. * Proven problem-solving ability. * Experience and demonstrated success in the healthcare environment and working directly with physicians. * Strong conflict management skills and objectivity in conflict resolution. * Knowledgeable in current and possible future practice trends, technology and information affecting the business and organization. * Strong organizational skills to effectively delegate tasks and ensure timelines. * Excellent problem-solving skills to devise effective solutions for organizational challenges * Professional conduct, which includes upholding ethical and professional standards * An understanding of their organization's structure and functions * Developing strategies to improve the quality of patient care, satisfaction, and safety of patient care

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and 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 * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. •Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse incidents and quality of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. * Reviews quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. * Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. * Ensures medical protocols and rules of conduct for plan medical personnel are followed. * Develops and implements plan medical policies. * Provides implementation support for quality improvement activities. * Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. * Actively participates in regulatory, professional and community activities. Required Qualifications * At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. * Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. * Board certification. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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 #PJHS #LI-AC1 Pay Range: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

Provides medical oversight and expertise in appropriateness and medical necessity of services provided to members, targeting improvements in efficiency and satisfaction for both members and providers and 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 * Determines appropriateness and medical necessity of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure high-quality member care - ensuring members receive the most appropriate care at the most effective setting. •Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and under-utilization. * Educates and interacts with network, group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management. * Assumes leadership relative to knowledge, implementation, training, and supervision of the use of the criteria for medical necessity. * Participates in and maintains the integrity of the appeals process, both internally and externally. * Responsible for investigation of adverse incidents and quality of care concerns. * Participates in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership and consultation for NCQA standards/guidelines for the plan including compliant clinical quality improvement activity (QIA) in collaboration with clinical leadership and quality improvement teams. * Facilitates conformance to Medicare, Medicaid, NCQA and other regulatory requirements. * Reviews quality referred issues, focused reviews and recommends corrective actions. * Conducts retrospective reviews of claims and appeals and resolves grievances related to medical quality of care. * Attends or chairs committees as required such as credentialing, Pharmacy and Therapeutics (P&T) and other committees as directed by the chief medical officer. * Evaluates authorization requests in timely support of nurse reviewers, reviews cases requiring concurrent review and manages the denial process. * Monitors appropriate care and services through continuum among hospitals, skilled nursing facilities and home care to ensure quality, cost-efficiency, and continuity of care. * Ensures that medical decisions are rendered by qualified medical personnel and not influenced by fiscal or administrative management considerations, and that care provided meets the standards for acceptable medical care. * Ensures medical protocols and rules of conduct for plan medical personnel are followed. * Develops and implements plan medical policies. * Provides implementation support for quality improvement activities. * Stabilizes, improves and educates primary care physicians and specialty networks; monitors practitioner practice patterns and recommends corrective actions as needed. * Fosters clinical practice guideline implementation and evidence-based medical practices. * Utilizes information technology and data analytics to produce tools to report, monitor and improve utilization management. * Actively participates in regulatory, professional and community activities. Required Qualifications * At least 3 years health care experience, including at least 2 years of medical practice experience, or equivalent combination of relevant education and experience. * Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO) license in state of practice. * Board certification. * Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. * Ability to work cross-collaboratively within a highly matrixed organization. * Strong organizational and time-management skills. * Ability to multi-task and meet deadlines. * Attention to detail. * Critical-thinking and active listening skills. * Decision-making and problem-solving skills. * Strong verbal and written communication skills. * Microsoft Office suite/applicable software program(s) proficiency, and ability to learn new programs. Preferred Qualifications * Experience with utilization/quality program management. * Managed care experience. * Peer review experience. * Certified Professional in Healthcare Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) or other health care or management certification. 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: $186,201.39 - $363,093 / ANNUAL * Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level. 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.

The Program Medical Director has oversight responsibility for the Hospitalist Program at the site they direct. The Program Medical Directors report directly to the VP of Hospital Medicine. The Program Medical Director is responsible for all Quality Outcomes and Clinical performance of their Hospitalist Program. The Program Medical Director collaborates with the MVHN Chief Medical Officer and Associate Chief Nursing Officer in meeting organizational goals. This individual will be responsible for leading and implementing initiatives to deliver patient-centered, high-quality and equitable cost-effective care to patients cared for by the hospitalist. Nature and Scope The Program Medical Director is responsible for the management of the Hospitalist Program and has direct oversight of the hospitalist physicians and APPs in the program. Principal Duties and Responsibilities Staff Hospitalist and APP Oversight * Management of financial and quality performance of their Hospitalist Program * Operations management, marketing, staffing, HR issues, budgeting, clinical performance, strategic planning and recruitment * Provides mentorship and holds Hospitalists and APP staff providers accountable for meeting the terms of their individual signed contracts and performance metric goals of the Hospitalist department and hospital. * Determines strategic plans to carry out clinical initiatives proposed by leadership related to committee involvement, education and training requirements, care standards m processes, and patient flow guidelines for the successful implementation of the plans by the Hospitalists team. * Ensures fiscally responsible adequate staffing of shifts at all times to simultaneously ensure patient safety and budgetary requirements are maintained. * Participates in the hiring of Hospitalists department staff and providers, monitors compensation and incentive programs, establishes processes to ensure equity among all employed/hired Hospitalists providers, and defines staffing model guidelines. * Participates in the implementation and monitoring of physician compensation and bonus plans designed to enhance care improvement, improved clinical outcomes, promote efficiency and fiscal accountability, and recruits/retains talent. * Participates in the evaluation and leads adoption of technology to support clinical excellence and program performance. Financial Oversight * In partnership with leadership recommends annual operating budgets maintains fiscal accountability through monitoring actual performance to budget and recommends any major changes or adjustments from budget to improve staffing, compensation, and capital. * Ensures revenue cycle is optimized to achieve maximum reimbursement with appropriate billing, coding, documentation and length of stay. * Supports finance leadership in establishing the financial infrastructure and budget for the hospitalists program at the site of supervision. Patient Experience * Recommends and maintains accountability to goals for quality, safety, and satisfaction that enhance value, improve patient experience and outcomes while providing evidence-based medicine to achieve the safest care and most cost-effective care. * Develops and operationalizes the standardization of hospitalist-based services throughout the Premier Health System based on evidence-based medicine and best practices to drive quality, service and cost-effective delivery of Hospitalist care across the hospital. * Monitors and implements continuous process improvement initiatives to improve the operational efficiency of Hospitalists medicine focusing on QEP metrics, clinical outcomes, and hospital throughput. * Develops plans to achieve patient experience service and provider satisfaction goals. * Establishes rapport and credibility with hospital site senior leaders to ensure alignment of goals with the clinical quality goals of the hospital. Qualifications * MD or DO degree * Board certification in IM or FM * Unrestricted OHIO license * Previous leadership and management experience preferred * Experience in Quality Improvement * Fundamental knowledge of financial decision-making * Privileged or actively pursuing privileges at all MVH Sites. * H1B and J1 candidates can be considered for this role

The Associate Director, GME Accreditation & Operations supports the oversight, development, and continuous improvement of Graduate Medical Education (GME) programs. This role collaborates with corporate and facility GME leadership to ensure program compliance, quality, and operational excellence in alignment with Accreditation Council for Graduate Medical Education (ACGME) standards. The Manager may provide guidance for new and existing program accreditations, assists in implementing quality improvement initiatives, and offers training and support to GME staff. Essential Functions Collaborates with GME leadership to develop, implement, and refine processes and procedures across clinical and educational GME settings. Provides guidance to facility GME leadership and program staff to ensure excellence in GME program operations and adherence to ACGME standards. Assists in the development and accreditation of new GME programs, providing expertise and support in accreditation processes. Leads or participates in quality improvement initiatives to enhance onboarding, training, and administrative skills for GME program staff. Acts as a resource for GME program leadership, supporting a consistent and compliant approach across all programs. Communicates effectively with corporate and facility GME teams, promoting collaboration and alignment on program goals and standards. Monitors program compliance, assesses areas for improvement, and implements strategies to enhance operational efficiency and program quality. Provides training and resources to program leaders and staff, as needed. Performs other duties as assigned. Complies with all policies and standards. Qualifications Bachelor's Degree in Healthcare Administration, Education, or a related field required Master's Degree in Education, Healthcare Administration, Organizational Leadership, or Behavioral Science/Social Work preferred 4-6 years of experience in GME administration or healthcare program management required and 3-5 years of experience as a Program/Fellowship Coordinator at an ACGME-accredited program preferred Knowledge, Skills and Abilities Strong knowledge of GME accreditation standards, including ACGME requirements. Excellent leadership and mentoring skills to guide GME administrative staff and program leadership. Effective communication and interpersonal skills to foster collaboration and alignment across GME programs. Analytical skills for program assessment, quality improvement, and compliance monitoring. Ability to manage multiple priorities and adapt to changing regulatory and operational requirements. Experience with GMETrack, ACGME ADS, Thalamus, New Innovations, and ERAS required. Licenses and Certifications Certification in GME administration or related area preferred

This is a full time Nursing (RN) Director responsible for the inpatient Medical Surgical department at Physicians Regional Collier in Naples, FL. Benfits include: Medical, Dental, Company Match 401k, competative Paid Time Off, and more! Job Summary The Director, Med/Surg, is responsible for the overall leadership and management of the medical-surgical department, ensuring the delivery of safe, high-quality patient care and operational excellence. This role provides strategic direction, oversees departmental operations, and ensures compliance with healthcare regulations and organizational objectives. The Director fosters a culture of collaboration and continuous improvement while supporting staff development and patient satisfaction. Essential Functions Oversees clinical operations in the medical-surgical department, ensuring that patient care is delivered safely, efficiently, and in alignment with evidence-based practices and regulatory standards. Collaborates with physicians, nursing staff, and multidisciplinary teams to ensure seamless coordination of patient care across the continuum. Manages departmental budgets, staffing, and resource allocation to maintain financial efficiency while meeting patient care needs and maintaining high standards of service. Monitors key performance indicators and quality metrics, identifying opportunities for improvement and leading initiatives to optimize patient outcomes and departmental performance. Facilitates open communication and collaboration between clinical staff, administration, and external stakeholders to address patient care needs and operational challenges. Responds promptly to patient care concerns, complaints, and incidents, conducting investigations and implementing corrective actions as necessary. Maintains up-to-date knowledge of industry trends, emerging clinical practices, and regulatory changes, ensuring the department adapts to evolving healthcare environments. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards. Leadership Responsibilities Supervision and Staff Management Provides leadership, mentorship and professional development opportunities for departmental staff. Schedules employees to ensure effective use of resources. Consults with leadership on any potential staffing issues. Conducts performance evaluations, sets goals and provides feedback to staff on their performance and development. Strategic Planning and Financial Oversight Collaborates with hospital leadership to set the strategic direction for the department, including budgeting, resource allocation and long-term planning. Monitors expenditures, ensuring cost-effective delivery of services. Evaluates and implements new technologies to enhance operational efficiency. Develops and implements departmental policies and procedures and protocols to optimize quality and overall efficiencies. Quality Assurance and Regulatory Compliance Ensures compliance with all relevant regulatory bodies. May oversee the accreditation process with relevant agencies ensuring that services meet or exceed industry standards. Participates in audits, inspections and accreditation processes as applicable. Follows established quality control practices to ensure accuracy, consistency and safety. Collaboration and Communication Works closely with leadership teams to coordinate and improve service delivery. Stays up-to-date with industry advancements, new technologies, and regulatory changes. Staff Responsibilities May work in a staff role, when required. Ensures that duties and responsibilities are fulfilled while meeting all competencies established for that job. Qualifications Bachelor's Degree in relevant field required or Seven (7) plus years of direct experience in lieu of a Bachelor's degree required Master's Degree preferred 3-5 years of experience in closely related field with Bachelor's degree required 3-5 years of previous leadership experience preferred Knowledge, Skills and Abilities Strong leadership, organizational, and communication skills. Ability to collaborate with interdisciplinary teams and manage cross-functional relationships. Foster a positive work environment that promotes teamwork, professionalism, and continuous improvement. Communicate effectively with leadership, team members, and stakeholders. Ability to work effectively with others, delegate responsibilities, and independently manage tasks while meeting established deadlines. Problem-solving and critical thinking skills. In depth knowledge of industry best practices and regulatory compliance (if applicable). Strong organizational and time management skills. Proficiency with Google and Microsoft platforms, healthcare software systems, and data analysis tools. Licenses and Certifications RN - Registered Nurse - State Licensure and/or Compact State Licensure required Basic Life Support Program (BLS) - American Heart Association required INDLEAD

Advance public health impact with data, strategy and execution. Premier's Community Health Advisory Team helps state agencies and health leaders modernize systems, strengthen equity and turn policy into measurable performance through analytics, collaboration and hands-on expertise. What you will be doing: The Director works collaboratively within a team of highly qualified Advisory consultants to deliver performance improvement to healthcare. This position will be primarily responsible for performing billable work for clients. The role of Director is to provide leadership by driving engagement results, manage client relationships, manage engagement resources, oversee development of client deliverables and solutions, oversee implementation, manage risks and issues, manage project logistics and economics, and support business development opportunities. This position has oversight for projects of all sizes and durations, which includes accountability for the quality of results, project profitability, and customer satisfaction. The Director delivers consulting services while supervising, mentoring, and developing staff. The Director serves as subject matter expert on projects as needed. This position will also participate in sales and business development activities including sales calls, RFP responses, orals, statements of works preparation, etc. This position will collaborate with and develop strong client relationships across all levels of the client organization including clinical staff, physicians, and administrative leadership to meet deliverables. The Director is required to participate and lead in Premier internal activities including practice development, required, and approved educational opportunities throughout the year and learning the various technologies Premier offers to its clients. Additionally, the Director should: Maintain Utilization targets for client billable projects. Create value through meaningful client relationship management, solution development and implementation delivery. Create a team environment by enriching staff skills and knowledge and create a productive and collaborative environment. Create value for the Advisory practice through meaningful participation in practice related activities aimed at growing and enriching the Practice as a whole or individual Service Lines within the Practice Actively participate in add on sales activities and new sales business development opportunities. . Key Responsibilities Responsibility #1 Execute/direct/oversee data analyses, initiate interpretations and conclusions, and oversee verbal and graphic presentations, using methods that are professionally sound and efficient relative to project objectives and conform to standards. Perform quality assurance on project deliverables. Assist in determining client needs by effectively leading client interviews and utilizing various tools and analytical methods. Summarize analytical findings in a coherent manner and draws insight from observations, interviews and data analyses. Develop accurate conclusions from findings. Drafts recommendations and potential solutions for team leadership review. Develops final recommendations and solutions for client review. Effectively execute on project plans in accordance with engagement statements of work and to client satisfaction. Guide team in developing presentations and deliverables for client audiences that communicate strategy and outcomes. Generate billings revenue by leading the engagements in the project delivery. Guide and lead project management related activities for assigned projects. Manage the budget and expenses for their assigned projects and manage project profitability. Manage staff assigned to their projects including providing mentoring and education for staff. Participate in risk and issue identification and mitigation along with the project leadership team. Identify opportunities for add on sales and communicate those to engagement leadership and participate in activities to aid in closing those opportunities. Responsibility #2 Actively listen for market opportunities on current engagements and collaborative networks and communicates potential leads to managers. Contribute to the development of sales presentation deliverables using prescribed formats and technology; proactively seeks out opportunities to participate. Identifies opportunities to improve profitability. Responsibility #3 Complete all required training requirements on an annual basis. Will aid in developing training materials for the practice in areas of their expertise. Required Qualifications Work Experience: Years of Applicable Experience - 7 or more years Education: Bachelors (Required) Preferred Qualifications Skills: Coordinate and deliver effective presentations (verbal and written) to client audiences to communicate project outcomes, recommendations, and strategy Ability to oversee, quality assure analytics and oversee and mentor others in the delivery and production of client deliverables Ability to relate to clients and team members in an effective and collaborative manner Ability to lead work groups to successful outcomes Demonstrated depth of knowledge in a specific area of expertise (i.e., Subject Matter Expert) Experience: Experience in Health Systems Finance, Operations (clinical, support or operations), Strategic Planning or Decision Support Analytics Qualitative analysis and strategic problem-solving skills Experience leading cross-functional teams Education: Master's Degree; RN or other professional license in clinical are of expertise; PMP/Lean Certification This is a remote position and requires up to 75% travel. Additional Job Requirements: Remain in a stationary position for prolonged periods of time Be adaptive and change priorities quickly; meet deadlines Attention to detail Operate computer programs and software Ability to communicate effectively with audiences in person and in electronic formats. Day-to-day contact with others (co-workers and/or the public) Making independent decisions Ability to work in a collaborative business environment in close quarters with peers and varying interruptions Working Conditions: Remote Travel Requirements: Travel 81-100% within the US Physical Demands: Sedentary: Exerting up to 10 pounds of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves remaining stationary most of the time. Jobs are sedentary if movement is required only occasionally, and all other sedentary criteria are met. Premier's compensation philosophy is to ensure that compensation is reasonable, equitable, and competitive in order to attract and retain talented and highly skilled employees. Premier's internal salary range for this role is $141,000 - $234,000. Final salary is dependent upon several market factors including, but not limited to, departmental budgets, internal equity, education, unique skills/experience, and geographic location. Premier utilizes a wide-range salary structure to allow base salary flexibility within our ranges. Employees also receive access to the following benefits: · Health, dental, vision, life and disability insurance · 401k retirement program · Paid time off · Participation in Premier's employee incentive plans · Tuition reimbursement and professional development opportunities Premier at a glance: Ranked #1 on Charlotte's Healthiest Employers list for 2019, 2020, 2022, and 2023 and 21st Healthiest Employer in America (2023) Named one of the World's Most Ethical Companies by Ethisphere Institute for the 16th year in a row Modern Healthcare Best in Business Awards: Consultant - Healthcare Management (2024) The only company to be recognized by KLAS twice for Overall Healthcare Management Consulting For a listing of all of our awards, please visit the Awards and Recognition section on our company website. Employees receive: Perks and discounts Access to on-site and online exercise classes Premier is looking for smart, agile individuals like you to help us transform the healthcare industry. Here you will find critical thinkers who have the freedom to make an impact. Colleagues who share your thirst to learn more and do things better. Teammates committed to improving the health of a nation. See why incredible challenges require incredible people. Premier is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to unlawful discrimination because of their age, race, color, religion, national origin, ancestry, citizenship status, sex, sexual orientation, gender identity, gender expression, marital status, familial status, pregnancy status, genetic information, status as a victim of domestic violence, covered military or protected veteran status (e.g., status as a Vietnam Era veteran, disabled veteran, special disabled veteran, Armed Forces Serviced Medal veteran, recently separated veteran, or other protected veteran) disability, or any other applicable federal, state or local protected class, trait or status or that of persons with whom an applicant associates. We also consider qualified applicants with criminal histories, consistent with applicable federal, state and local law. In addition, as a federal contractor, Premier complies with government regulations, including affirmative action responsibilities, where they apply. EEO / AA / Disabled / Protected Veteran Employer. Premier also provides reasonable accommodations to qualified individuals with a disability or those who have a sincerely held religious belief. If you need assistance in the application process, please reply to diversity_and_accommodations@premierinc.com or contact Premier Recruiting at ************. Information collected and processed as part of any job application you choose to submit to Premier is subject to Premier's Privacy Policy.

The Clinical Neuroscience Inst-MVH - Neurosurgery FT/ 80 hours per pay The Premier Physician Network offers a variety of Nurse Practitioner / Physician Assistant positions with varying degrees of responsibility. Our APP's, in conjunction with the center's Physician/s and clinical staff, are responsible for exemplary patient primary health care and continuity of medical services under the direction of the supervising physician/s. Responsibilities will vary with each position, and also according to specialty; must be accessible to their physicians, staff and supervisors. Nature and Scope Knowledge of professional medical practice to give and evaluate patient care. Skilled in applying and modifying the principles, methods and techniques of medicine to provide ongoing patient care. Competent in taking medical history, assessing medical condition and interpreting findings. Ability to maintain quality assurance and quality control standards. Capable of reacting calmly and effectively in emergency situations. Excellent communication skills with both patients and colleagues are essential. Qualifications * Applicants must hold a Master's degree from an accredited NP / PA program. * Applicant must be a certified CNS / NP / PA. Current State of Ohio licensure is required and should be maintained at all times. * Certificate to Prescribe must be current and maintained at all times. * A thorough understanding of HIPAA law is required and professional discretion must be demonstrated at all times. * Applicant must have excellent oral and written communication skills. Excellent communication skills with both patients and colleagues are essential. * Computer literacy is required and must include Excel, Word and Outlook, and Electronic Medical Records experience is an advantage, preferably EPIC.