89 Medical Assistants jobs in New Baltimore

Oncology Nurse

**Sign-on Bonus available!**

$1,500 for full-time positions

$750 for part-time positions

General Summary:

Provides care to the patient according to the plan of care, unit routine and hospital policy under the direction of a Registered Nurse.

Unit Description:

8 South Oncology is a 44 bed, adult inpatient unit driven by the complex clinical and psychosocial needs of the Oncology patient population. Nurses on this unit care for patients experiencing various stages and complications from hematology/oncology diagnosis. Patients may range from the newly diagnosed to those seeking end of life care. Our unit provides the opportunity to develop critical thinking and assessment skills while working with high acuity patients, managing the latest chemotherapy and biotherapy regimes, blood product administrations, pain management, and central line care. In addition to the technical aspects of the position, 8 South provides the unique opportunity to develop and maintain strong relationships with patients and their families throughout the course of their treatment.

Benefits:

Corewell Health offers a comprehensive benefits package to meet your financial, health and life-work balance goals.

• New On-demand pay program powered by Payactiv
• Generous paid time off, holidays and flexible scheduling
• Special discounts on a wide range of products and services
• Exceptional health, dental, vision and prescription drug insurance plans
• Relocation assistance
• Generous retirement savings, disability insurance, identity theft protection and even home and auto insurance
• Free onsite parking at all campuses

Standard Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential duties.

Education / Training:

• High school graduate or equivalent

Work Experience:

• Previous hospital or nursing home experience preferred

Certification, Licensure, Registration:

• American Heart Association or American Red Cross Basic Life Support required
• Current CNA certification preferred

Other Qualifications:

• Ability to communicate effectively and document information accurately.
• Ability to deal efficiently and effectively with a wide variety of individuals.
• Knowledge of basic medical terminology preferred.
• Basic computer knowledge is preferred.
• Ability to move or lift patients and equipment.
• Ability to demonstrate Beaumont customer service standards and behaviors in all aspects of job performance

Essential Duties:

• Providing care to the patient according to the plan of care, specific unit routines and hospital policy under the Direction of the Registered Nurse.
• Documentation of care provided in the electronic medical record.
• Safe transport of patients via wheelchair or stretcher, dispatch services and appropriate documentation of services.
• Provides the services of an Observer for any patient on a patient care unit who has been assessed to require constant observation, either in person or via remote video monitoring, to maximize his/her safety.
• Performs general receptionist and clerical duties to facilitate efficient functioning of the nursing unit.
• Maintains current knowledge/certification.
• Attends all required Safety Training programs and can describe his/her responsibilities related to general safety, department/service safety and specific job-related hazards.
• Follows the Hospital Exposure Control Plans/Bloodborne and Airborne Pathogens.
• Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to ensure a professional, responsible and courteous environment.
• Promotes effective working relations and works effectively as part of a department/unit team inter and intra departmentally to facilitate the department's/unit's ability to meet its goals and objective.

Working Conditions:

• Physical Effort: Extensive bending and lifting. Must be able to transfer patients from wheelchair to stretcher.
• Work Environment: Employee may be frequently exposed to electro-magnetic radiations as in VDTs. Occasionally exposed to hazardous material other than blood, body tissues, or fluids, dust, toxins, cytotoxions, chemical hazardous materials, bodily injuries, loud and/or unpleasant noises, high humidity, electrical hazards, or poisonous substances. Infrequently exposed to blood, body tissue, or fluids. Seldom exposed to fluctuations in temperature, grease, oil, and radiation.

Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of more than 60,000 dedicated people including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities and Priority Health, a provider-sponsored health plan serving more than 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.

Sign-on Bonus available!

$1,500 for full-time positions

$750 for part-time positions

GENERAL SUMMARY:

Provides care to the patient according to the plan of care, unit routine and hospital policy under the direction of a Registered Nurse.

UNIT DESCRIPTION:

8 South Oncology is a 44 bed, adult inpatient unit driven by the complex clinical and psychosocial needs of the Oncology patient population. Nurses on this unit care for patients experiencing various stages and complications from hematology/oncology diagnosis. Patients may range from the newly diagnosed to those seeking end of life care. Our unit provides the oppo rtunity to develop critical thinking and assessment skills while working with high acuity patients, managing the latest chemotherapy and biotherapy regimes, blood product administrations , pain management, and central line care . In addition to the technical aspects of the position, 8 South provides the unique opportunity to develop and maintain strong relationships with patients and their families throughout the course of their treatment.

BENEFITS :

Corewell Health offers a comprehensive benefits package to meet your financial, health and life-work balance goals.

• NEW On-demand pay program – powered by Payactiv

• Generous paid time off, holidays and flexible scheduling

• Our employees receive special discounts on a wide range of products and services

• Exceptional health, dental, vision and prescription drug insurance plans

• Relocation assistance

• Generous retirement savings, disability insurance, identify theft protection and even home and auto insurance

• Free onsite parking at all campuses

STANDARD QUALIFICATIONS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required . Reasonable accommodation may be made to enable individuals with disabilities to perform the essential duties.

Education / Training:

• High school graduate or equivalent

Work Experience:

• Previous hospital or nursing home experience preferred

Certification, Licensure, Registration:

• American Heart Association or American Red Cross Basic Life Support required

• Current CNA certification preferred

Other Qualifications:

• Ability to communicate effectively and document information accurately.

• Ability to deal efficiently and effectively with a wide variety of individuals.

• Knowledge of basic medical terminology preferred.

• Basic computer knowledge is preferred.

• Ability to move or lift patients and equipment.

• Ability to demonstrate Beaumont customer service standards and behaviors in all aspects of job performance

ESSENTIAL DUTIES:

• Providing care to the patient according to the plan of care, specific unit routines and hospital policy under the Direction of the Registered Nurse.

• Documentation of care provided in the electronic medical record.

• Safe transport of patients via wheelchair or stretcher, dispatch services and appropriate documentation of services.

• Provides the services of an Observer for any patient on a patient care unit who has been assessed to require constant observation, either in person or via remote video monitoring, to maximize his/her safety.

• Performs general receptionist and clerical duties to facilitate efficient functioning of the nursing unit.

• Maintains current knowledge/certification.

• Attends all required Safety Training programs and can describe his/her responsibilities related to general safety, department/service safety and specific job-related hazards.

• Follows the Hospital Exposure Control Plans/Bloodborne and Airborne Pathogens.

• Demonstrates respect and regard for the dignity of all patients, families, visitors and fellow employees to ensure a professional, responsible and courteous environment.

• Promotes effective working relations and works effectively as part of a department/unit team inter and intra departmentally to facilitate the department's/unit's ability to meet its goals and objective .

This document represents the major duties, responsibilities, and authorities of this job, and is not intended to be a complete list of all tasks and functions. It should be understood, therefore, that incumbents may be asked to perform job-related duties beyond those explicitly described.

WORKING CONDITIONS:

• Physical Effort:

• Extensive bending and lifting. Must be able to transfer patients from wheelchair to stretcher.

• Work Environment:

• Employee may be frequently exposed to electro-magnetic radiations as in VDTs. Occasionally exposed to hazardous material other than blood, body tissues, or fluids, dust, toxins, cytotoxions , chemical hazardous materials, bodily injuries, loud and/or unpleasant noises, high humidity, electrical hazards, or poisonous substances. Infrequently exposed to blood, body tissue, or fluids. Seldom exposed to fluctuations in temperature, grease, oil, and radiation.

Corewell Health

People are at the heart of everything we do, and the inspiration for our legacy of outstanding outcomes, innovation, strong community partnerships, philanthropy and transparency . Corewell Health is a not-for-profit health system that provides health care and coverage with an exceptional team of more than 60,000 dedicated people – including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities – and Priority Health, a provider-sponsored health plan serving more than 1.2 million members . Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.

How Corewell Health cares for you

• Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here ( .

• On-demand pay program powered by Payactiv

• Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!

• Optional identity theft protection, home and auto insurance, pet insurance

• Traditional and Roth retirement options with service contribution and match savings

• Eligibility for benefits is determined by employment type and status

Primary Location

SITE - Royal Oak Hospital - 3601 W 13 Mile Road - Royal Oak

Department Name

Nursing Medical Oncology 8S - Royal Oak

Employment Type

Full time

Shift

Day (United States of America)

Weekly Scheduled Hours

36

Hours of Work

6:30 a.m. to 7 p.m.

Days Worked

Monday to Friday

Weekend Frequency

Variable weekends

CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

You may request assistance in completing the application process by calling .

Job Description

Job Description

EyeCare Partners is the nation's leading provider of clinically integrated eye care. Our national network of over 300 ophthalmologists and 700 optometrists provides a lifetime of care to our patients with a mission to enhance vision, advance eye care and improve lives. Based in St. Louis, Missouri, over 650 ECP-affiliated practice locations provide care in 18 states and 80 markets, providing services that span the eye care continuum. For more information, visit

Company: Valley Eye Institute
Job Title: Ophthalmic Technician
Department: Ophthalmology
Reports To: Clinic Supervisor
Location: This position is located in Troy, OH and may require travel to Beavercreek, Piqua, Sidney, and Bellefontaine. We pay mileage!

SUMMARY

An Ophthalmic Technician is a valuable asset to an Ophthalmologist as they assist in providing excellent patient care to the patients during their visit. This employee is able to handle a wide range of duties while using equipment to perform the initial testing needed to prepare a patient for an exam with an Ophthalmologist.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Provide exceptional customer service during every patient encounter (in person or via phone)
• Display a professional attitude, greet patients promptly with a smile, and thank them when they leave
• Anticipate Physician needs to facilitate the flow of the clinic
• Practice urgency at all times with patient's time, as well as doctor's time and schedule
• Comply with all company policies and procedures, including HIPAA
• Verify patient's information by interviewing patient
• Record patient's medical history and current medications and confirm purpose of visit
• Record all data in the patient's Electronic Medical Record (EMR)
• Check condition of patient's eyes by observing pupils, muscles, visual acuity, and extraocular movements
• Required skills include: dilation, refraction, pressures, and performing a variety of diagnostic tests including visual fields, OCT, GDX, IOL master, auto refractor and topography
• Demonstrates working knowledge of eye anatomy, diseases, symptoms and ocular medications
• Accurately and thoroughly document medical visits and procedures as they are being performed by the Physician
• Prepare patients for treatments and minor procedures; measure and record vital signs (blood pressure, pulse, and respiration rate) as required
• Open and close exam rooms as needed
• Keep examination, treatment, laser and any other assigned rooms cleaned and stocked with supplies, and keep drug count up to date.
• General office duties and cleaning to be assigned by manager
  
  

QUALIFICATIONS

• Provides excellent patient care and is energetic and empathetic with patients
• Must comply with HIPAA confidentiality standards when communicating patient information
• Communication skills and the ability to coordinate and cooperate with all levels of employees in a courteous, professional manner at all times
• Organizational skills with focus on tracking patient care and improving patient flow
• Desire to gain industry knowledge and training
• Demonstrates initiative in accomplishing practice goals
• Ability to grow, adapt, and accept change
• Consistently creates a positive work environment by being team-oriented and patient-focused
• Commitment to work over 40 hours to meet the needs of the business
• Ability to work weekends when applicable
• Reliable transportation that would allow employee to go to multiple work locations with minimal notice
  
  

EDUCATION AND/OR EXPERIENCE

• Minimum Required: High school diploma or general education degree (GED) required
• Minimum Required: One year of related experience and/or training; or equivalent combination of education and experience
  
  

LICENSES AND CREDENTIALS

• Current Certified Ophthalmic Assistant (COA) or Certified Ophthalmic Technician (COT) certification is preferred, but not required
  

SYSTEMS AND TECHNOLOGY

• Proficient in Microsoft Excel, Word, PowerPoint, Outlook
• Experience using Electronic Medical Records (EMR) systems
• Computer proficiency and ability to quickly learn new applications
  
  

PHYSICAL REQUIREMENTS

• This role requires a variety of physical activities to effectively perform essential job functions. The position involves frequent walking (75%), sitting (50%), and standing (50%), with regular bending, stooping, and reaching (25–50%). Employees must be able to lift, carry, push, and pull items up to 25 lbs. Strong fine motor skills and full use of hands are essential, as the role demands constant grasping, writing/typing, and use of technology. Visual and auditory acuity—including color, depth, peripheral vision, and the ability to adjust focus—is required 100% of the time. Occasional driving or climbing may also be necessary.
  
  

Perks:

• Full Benefits Package - Medical, Vision, Dental and Life Insurance
• 401k + Employer Matching
• Paid Time Off and Paid Holidays
• Paid Maternity Leave
• Optical Education Reimbursement
• Competitive Base Pay

If you need assistance with this application, please contact ( . Please do not contact the office directly – only resumes submitted through this website will be considered.

EyeCare Partners is an equal opportunity/affirmative action employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status.

Duties:

• Assist healthcare professionals in providing patient care
• Perform administrative tasks such as scheduling appointments and maintaining medical records
• Take patient vitals, including blood pressure, temperature, and pulse
• Prepare patients for examinations and procedures
• Administer medications as directed by healthcare providers
• Perform basic laboratory tests and collect specimens
• Assist with patient education and provide instructions for at-home care
• Ensure compliance with infection control protocols

Experience:

• High school diploma or equivalent required
• Completion of a medical assistant program or certification preferred
• Previous experience working in a medical office or healthcare setting is a plus
• Knowledge of medical terminology and basic clinical procedures
• Proficient in using electronic health record (EHR) systems
• Excellent communication and interpersonal skills
• Ability to multitask and work in a fast-paced environment

Summary As a Medical Assistant, you will be a vital part of the healthcare team, providing essential medical administrative support and patient care services. With core skills in medical terminology, patient service, and basic life support, you will assist in intake procedures, vital sign measurements, and EHR system management. Your premium skills in urgent care will enhance your ability to support medical professionals effectively. Additionally, your relevant experience in outpatient clinics, will contribute to the efficient delivery of healthcare services. Join our team and make a difference in patient care in a dynamic healthcare setting.

JOB DESCRIPTION

Job Summary

Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provisions of medical staff services. Maintains a working knowledge of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff.

Job Duties

• Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management.

• Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership position 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 the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff.

• 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, P&T and others 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, not influenced by fiscal or administrative management considerations, and that the care provided meets the standards for acceptable medical care.

• Ensures that 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 the Primary Care Physician and Specialty networks. Monitors practitioner practice patterns and recommends corrective actions if needed.

• Fosters Clinical Practice Guideline implementation and evidence-based medical practice.

• Utilizes IT and data analysts to produce tools to report, monitor and improve Utilization Management.

• Actively participates in regulatory, professional and community activities.

• Must be able to get additional licensures in multiply states.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Doctorate Degree in Medicine

• Board Certified in a primary care specialty

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 3+ years relevant experience, including:

• 2 years previous experience as a Medical Director in a clinical practice.

• Current clinical knowledge.

• Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.

• Knowledge of applicable state, federal and third party regulations

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

Current state Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.

PREFERRED EDUCATION:

• Master’s in Business Administration, Public Health, Healthcare Administration, etc.

PREFERRED EXPERIENCE:

• Peer Review, medical policy/procedure development, provider contracting experience.

• Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.

• Experience in Utilization/Quality Program management

• HMO/Managed care experience

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

• Board Certification (Primary Care preferred).

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $161,914.25 - $315,733 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

JOB DESCRIPTION

Job Summary

Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provisions of medical staff services. Maintains a working knowledge of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff.

Job Duties

• Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management.

• Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership position 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 the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff.

• 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, P&T and others 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, not influenced by fiscal or administrative management considerations, and that the care provided meets the standards for acceptable medical care.

• Ensures that 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 the Primary Care Physician and Specialty networks. Monitors practitioner practice patterns and recommends corrective actions if needed.

• Fosters Clinical Practice Guideline implementation and evidence-based medical practice.

• Utilizes IT and data analysts to produce tools to report, monitor and improve Utilization Management.

• Actively participates in regulatory, professional and community activities.

• Must be able to get additional licensures in multiply states.

JOB QUALIFICATIONS

REQUIRED EDUCATION:

• Doctorate Degree in Medicine

• Board Certified in a primary care specialty

REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:

• 3+ years relevant experience, including:

• 2 years previous experience as a Medical Director in a clinical practice.

• Current clinical knowledge.

• Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.

• Knowledge of applicable state, federal and third party regulations

REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:

Current state Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.

PREFERRED EDUCATION:

• Master’s in Business Administration, Public Health, Healthcare Administration, etc.

PREFERRED EXPERIENCE:

• Peer Review, medical policy/procedure development, provider contracting experience.

• Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.

• Experience in Utilization/Quality Program management

• HMO/Managed care experience

PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:

• Board Certification (Primary Care preferred).

PHYSICAL DEMANDS:

Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $161,914.25 - $315,733 / ANNUAL

*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**JOB DESCRIPTION**
**Job Summary**
Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provisions of medical staff services. Maintains a working knowledge of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff.
**Job Duties**
+ Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management.
+ Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership position 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 the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff.
+ 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, P&T and others 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, not influenced by fiscal or administrative management considerations, and that the care provided meets the standards for acceptable medical care.
+ Ensures that 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 the Primary Care Physician and Specialty networks. Monitors practitioner practice patterns and recommends corrective actions if needed.
+ Fosters Clinical Practice Guideline implementation and evidence-based medical practice.
+ Utilizes IT and data analysts to produce tools to report, monitor and improve Utilization Management.
+ Actively participates in regulatory, professional and community activities.
+ Must be able to get additional licensures in multiply states.
**JOB QUALIFICATIONS**
**REQUIRED EDUCATION:**
+ Doctorate Degree in Medicine
+ Board Certified in a primary care specialty
**REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:**
+ 3+ years relevant experience, including:
+ 2 years previous experience as a Medical Director in a clinical practice.
+ Current clinical knowledge.
+ Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.
+ Knowledge of applicable state, federal and third party regulations
**REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:**
Current state Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
**PREFERRED EDUCATION:**
+ Master's in Business Administration, Public Health, Healthcare Administration, etc.
**PREFERRED EXPERIENCE:**
+ Peer Review, medical policy/procedure development, provider contracting experience.
+ Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
+ Experience in Utilization/Quality Program management
+ HMO/Managed care experience
**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:**
+ Board Certification (Primary Care preferred).
**PHYSICAL DEMANDS:**
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $161,914.25 - $315,733 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

**JOB DESCRIPTION**
**Job Summary**
Responsible for serving as the primary liaison between administration and medical staff. Assures the ongoing development and implementation of policies and procedures that guide and support the provisions of medical staff services. Maintains a working knowledge of applicable national, state, and local laws and regulatory requirements affecting the medical and clinical staff.
**Job Duties**
+ Provides medical oversight and expertise in appropriateness and medical necessity of healthcare services provided to members, targeting improvements in efficiency and satisfaction for patients and providers, as well as meeting or exceeding productivity standards. Educates and interacts with network and group providers and medical managers regarding utilization practices, guideline usage, pharmacy utilization and effective resource management.
+ Develops and implements a Utilization Management program and action plan, which includes strategies that ensure a high quality of patient care, ensuring that patients receive the most appropriate care at the most effective setting. Evaluates the effectiveness of UM practices. Actively monitors for over and under-utilization. Assumes a leadership position 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 the investigation of adverse incidents and quality of care concerns. Participates in preparation for NCQA and URAC certifications. Develops and provides leadership for NCQA-compliant clinical quality improvement activity (QIA) in collaboration with the clinical lead, the medical director, and quality improvement staff.
+ 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, P&T and others 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, not influenced by fiscal or administrative management considerations, and that the care provided meets the standards for acceptable medical care.
+ Ensures that 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 the Primary Care Physician and Specialty networks. Monitors practitioner practice patterns and recommends corrective actions if needed.
+ Fosters Clinical Practice Guideline implementation and evidence-based medical practice.
+ Utilizes IT and data analysts to produce tools to report, monitor and improve Utilization Management.
+ Actively participates in regulatory, professional and community activities.
+ Must be able to get additional licensures in multiply states.
**JOB QUALIFICATIONS**
**REQUIRED EDUCATION:**
+ Doctorate Degree in Medicine
+ Board Certified in a primary care specialty
**REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES:**
+ 3+ years relevant experience, including:
+ 2 years previous experience as a Medical Director in a clinical practice.
+ Current clinical knowledge.
+ Experience demonstrating strong management and communication skills, consensus building and collaborative ability, and financial acumen.
+ Knowledge of applicable state, federal and third party regulations
**REQUIRED LICENSE, CERTIFICATION, ASSOCIATION:**
Current state Medical license without restrictions to practice and free of sanctions from Medicaid or Medicare.
**PREFERRED EDUCATION:**
+ Master's in Business Administration, Public Health, Healthcare Administration, etc.
**PREFERRED EXPERIENCE:**
+ Peer Review, medical policy/procedure development, provider contracting experience.
+ Experience with NCQA, HEDIS, Medicaid, Medicare and Pharmacy benefit management, Group/IPA practice, capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management, risk management, risk adjustment, disease management, and evidence-based guidelines.
+ Experience in Utilization/Quality Program management
+ HMO/Managed care experience
**PREFERRED LICENSE, CERTIFICATION, ASSOCIATION:**
+ Board Certification (Primary Care preferred).
**PHYSICAL DEMANDS:**
Working environment is generally favorable and lighting and temperature are adequate. Work is generally performed in an office environment in which there is only minimal exposure to unpleasant and/or hazardous working conditions. Must have the ability to sit for long periods. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential function.
To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Pay Range: $161,914.25 - $315,733 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.