Chief Medical Officer, Product

JOB DESCRIPTION Job Summary Provides executive level strategy and leadership to a national business segment (i.e. Medicare, Marketplace, advanced imaging/central utilization management services) in the development and execution of care management, utilization management and disease management programs. Develops clinical practice guidelines and oversees appropriateness and medical necessity of services provided to plan members - targeting improvements in efficiency and satisfaction for members and providers. Partners with executive leadership team to provide cohesive direction towards company goals. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties u2022 Provides executive strategy, vision and direction for the medical program for a designated Molina product(s). Responsible for performance and financial results, and keeps executive leadership apprised. u2022 Leads analysis of medical care cost and utilization data. u2022 Leads and manages the development of techniques to effectively correct identified and anticipated utilization problems while assuring that members receive the care they need. u2022 Offers a positive leadership role in key segment/product medical management initiatives aimed a optimizing utilization of medical resources. u2022 Establishes and/or leads the following types of national programs/initiatives using clinical and industry best practices: post-acute care (u201cSNFistu201d skilled nursing facility programs), model of care, palliative care, diabetes prevention, home health, prior authorizations/referrals. u2022 Provides national best practice strategic direction and oversight for segment population management (including care management, utilization management, auditing and training). u2022 Creates necessary cross-functional forums and uses data analysis to identify opportunities for medical cost trend and quality improvement to positively influence member care outcomes. u2022 Leads development and implementation of national medical policy, including recommendations for modifications to improve efficiency and effectiveness; designs standardized protocols, develops policy and ensures timely implementation in collaboration with health plan presidents and segment leadership, in addition to the enterprise clinical policy committee. u2022 Ensures compliance with medical policy and maintaining compliance with all federal, state and local regulatory guidelines. u2022 Designs standardized protocols, develops policy and ensures timely implementation with corporate and health plan input. u2022 Ensures adequate training occurs from knowledgeable staff and coordinates with other departments as needed. u2022 Focuses on continual refinement of operational processes by using process improvement principles (PDSA, Lean Six Sigma, etc.). u2022 Develops, performs and promotes interdepartmental integration and collaboration to enhance clinical services. u2022 Manages and evaluates team members in the performance of various clinical management activities. u2022 Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and performance indicators. u2022 Collaborates with other functional areas that interface with the segment including medical management, network contracting and provider relations, member services, claims management, payment integrity, pharmacy, quality and risk adjustment. u2022 Acts as a critical segment clinical leader for external providers, regulatory (local, state and federal) and accrediting agencies. u2022 Identifies potential areas of non-compliance by overseeing audits and provides advice and guidance to operational areas regarding effective processes, and policies and procedures. u2022 Collaborates with internal and external business partners to provide guidance and recommendations around the development, maintenance and enhancement of programs, products and services. u2022 Accountable for segment readiness for internal and external audits (local, state and federal) and the administration of industry best practices. u2022 Ensures appropriate preparation and the successful outcome of the utilization management program compliance audits. u2022 Ensures department policies, procedures and activities maintain adherence to, and are compliant with all state, federal, and delegating entity regulations and policies. u2022 Supports special/enterprise projects. Required Qualifications u2022 At least 12 years of relevant health care leadership experience, including clinical practice experience, and at least 2 years as a medical director in managed care organization supporting utilization management/quality program management, or equivalent combination of relevant education and experience. u2022 At least 7 years health care management/leadership experience. u2022 Active and unrestricted Doctor of Medicine (MD) or Doctor of Osteopathy (DO). License must be active and restricted in state of practice. u2022 Board certification. u2022 Working knowledge of applicable national, state, and local laws and regulatory requirements affecting medical and clinical staff. u2022 Experience demonstrating strong leadership and communication skills, consensus building, collaborative ability and financial acumen. u2022 Demonstrated ability to make strategic decisions. u2022 Excellent verbal and written communication skills. u2022 Microsoft Office proficiency. Preferred Qualifications u2022 Certified Professional in Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) certification, or other health care or management certification. u2022 Prior experience with process improvement activities, policy and procedure development, and operational efficiency. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V Pay Range: $283,189.04 - $552,219 / ANNUAL Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Created: 2025-11-17