Medical Director, Utilization & Quality

Molina Healthcare provides medical oversight to ensure appropriate and cost-effective care for members in Wisconsin, aiming to improve efficiency and satisfaction for members and providers. The role contributes to strategy and leadership in quality and outcomes across the network.

Key duties include evaluating medical necessity, guiding utilization practices, and leading compliance with NCQA/URAC, Medicare and Medicaid guidelines while educating providers and managing quality assurance