Director, Clinical Review Team - Medicaid Advisory Unit (MAU)

University of Illinois Chicago; Chicago (IL); On-site; USD 129,000 - 141,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

Life insurance

Retirement plan

Paid time off

Tuition waivers

Job summary

University of Illinois Chicago invites applications for a Director, Clinical Review Team within the Medicaid Advisory Unit in the Department of Medicine. The position leads clinical review programs, guiding policy interpretation and utilization review under state Medicaid policy.

The role supervises a diverse team, partners with state agencies, and advances strategic initiatives to improve program quality and efficiency. Benefits include a comprehensive package and tuition waivers.

Qualifications

• Bachelor's degree in nursing, public health, healthcare administration, or a related field.
• Seven (7) years of progressively responsible experience in healthcare, Medicaid programs, or policy environments.
• Experience leading complex programs with operational, clinical, or policy impact.
• Ability to influence policy and program outcomes with independent decision-making.

Responsibilities

• Lead design, implementation, and oversight of clinical review programs within Medicaid policy.
• Provide executive oversight of day-to-day operations across multiple programs; ensure quality and compliance.
• Supervise a multidisciplinary team and develop staff; drive performance and professional growth.
• Interpret clinical review workflows and provide expert consultation on complex cases and policy issues.

Skills

Analytical skills

Problem-solving

Communication skills

Leadership

Education

Bachelor's degree in nursing, public health, healthcare administration, or related field

Master's degree preferred

Job description

Director, Clinical Review Team - Medicaid Advisory Unit (MAU)

Hiring Department: Department of Medicine

Location: Chicago

Requisition ID: 1041619

Posting Close Date: 10/09/2026

Salary: The budgeted salary range for the position is $129,000 to $141,000.00.

About the University of Illinois Chicago

UIC is among the nation's preeminent urban public research universities, a Carnegie RU/VH research institution, and the largest university in Chicago. UIC serves over 34,000 students, comprising one of the most diverse student bodies in the nation and is designated as a Minority Serving Institution (MSI), an Asian American and Native American Pacific Islander Serving Institution (AANAPSI) and a Hispanic Serving Institution (HSI). Through its 16 colleges, UIC produces nationally and internationally recognized multidisciplinary academic programs in concert with civic, corporate and community partners worldwide, including a full complement of health sciences colleges. By emphasizing cutting-edge and transformational research along with a commitment to the success of all students, UIC embodies the dynamic, vibrant and engaged urban university. Recent "Best Colleges" rankings published by U.S. News & World Report, found UIC climbed up in its rankings among top public schools in the nation and among all national universities. UIC has over 300,000 alumni, and is one of the largest employers in the city of Chicago.

This position is intended to be eligible for benefits. This includes Health, Dental, Vision, Life Insurance, a Retirement Plan, Paid time Off, and Tuition waivers for employees and dependents.

Position Summary

The Director, Clinical Review Team serves in a senior leadership and advisory capacity within the Department of Medicine's Medicaid Advisory Unit (MAU), providing advanced clinical, analytical, and policy expertise to support the Illinois Department of Healthcare and Family Services (HFS). This position exercises a high degree of independent judgment and decision-making authority in the interpretation of complex clinical and Medicaid policy issues and the development of recommendations that influence statewide program design, utilization management strategies, and coverage determinations. The Director is responsible for leading the integration of clinical expertise into Medicaid policy development and program operations, overseeing a portfolio of complex clinical review initiatives, including prior authorization and utilization review programs. The role directs multidisciplinary teams, ensures the consistent application of clinical and policy standards, and advances strategic initiatives that enhance program efficiency, effectiveness, and quality. As a senior subject matter expert and institutional representative, the Director engages with HFS, the Office of Medicaid Innovation (OMI), and other governmental and external stakeholders, contributing to high-level policy discussions and cross-agency collaboration. This position has significant impact on program direction, operational performance, and the advancement of Medicaid clinical review strategies. This position performs work that is predominantly intellectual and requires the consistent exercise of discretion and independent judgment. The role is responsible for interpreting and developing clinical review workflows, providing expert consultation, and leading programs with significant institutional and statewide impact.

Duties & Responsibilities

Program Leadership and Strategy
Lead the strategic design, implementation, and oversight of clinical review programs and operational frameworks aligned with Medicaid policy, regulatory requirements, and organizational priorities. Exercise a high degree of independent judgment in translating federal and state Medicaid policies into programmatic guidance, operational procedures, and clinical review standards. Establish program goals, performance metrics, and quality benchmarks; evaluate outcomes and implement data-informed improvements. Identify and lead strategic initiatives to enhance program performance, improve operational efficiencies, and support innovation across Medicaid clinical review activities.

Operational Oversight and Decision-Making
Provide executive-level oversight of day-to-day operations across multiple complex programs, ensuring timely, accurate, and high-quality execution. Independently assess, prioritize, and resolve complex clinical, operational, and policy-related issues with significant programmatic and stakeholder impact. Develop, implement, and standardize workflows, protocols, and best practices to ensure consistency and quality across clinical review functions and multiple technical platforms. Ensure compliance with all applicable federal and state regulations, contractual requirements, and internal policies.

Supervision and Staff Development
Provide leadership and direction to a multidisciplinary team, including an Associate Director and program staff, with responsibility for hiring, onboarding, performance management, and staff development. Establish clear performance expectations, accountability structures, and professional development pathways to support a high-performing and responsive team. Mentor staff and cultivate advanced clinical, analytical, and policy expertise across the team.

Clinical and Policy Interpretation
Serve as a senior subject matter expert in healthcare operations and clinical review, providing guidance on complex cases, programmatic issues, and emerging healthcare practices. Interpret and apply Medi

Minimum Qualifications

• Bachelor's degree in nursing, public health, healthcare administration, or a related field
• Seven (7) years of progressively responsible experience demonstrating advanced clinical, analytical, and program leadership expertise in healthcare, Medicaid programs, or policy-driven environments
• Demonstrated experience leading complex, multi-program initiatives with significant operational, clinical, or policy impact
• Proven ability to apply specialized knowledge to interpret, develop, and influence policy and program outcomes
• Demonstrated experience exercising independent decision-making authority in complex, high-impact situations with minimal oversight
• Experience supervising and developing multidisciplinary teams, including responsibility for performance management and staff development
• Strong knowledge of healthcare delivery systems, clinical operations, and Medicaid policy structures
• Demonstrated ability to engage and advise senior leadership, state agencies, and external stakeholders
• Excellent analytical, problem-solving, and communication skills

Preferred Qualifications

• Master's degree in public health, healthcare administration, business administration, or a related field
• Active Registered Nurse (RN) licensure or equivalent clinical credential
• Experience advising or partnering with state Medicaid agencies or public-sector healthcare programs
• Demonstrated experience developing and implementing healthcare policies, utilization management strategies, or large-scale program initiatives
• Experience in population health, public health systems, or healthcare transformation initiatives
• Experience leading teams in complex, high-stakes environments requiring rapid decision-making and cross-functional coordination

• Familiarity with quality improvement methodologies and healthcare performance metrics

• Bachelor's degree in nursing, public health, healthcare administration, or a related field
• Seven (7) years of progressively responsible experience demonstrating advanced clinical, analytical, and program leadership expertise in healthcare, Medicaid programs, or policy-driven environments
• Demonstrated experience leading complex, multi-program initiatives with significant operational, clinical, or policy impact
• Proven ability to apply specialized knowledge to interpret, develop, and influence policy and program outcomes
• Demonstrated experience exercising independent decision-making authority in complex, high-impact situations with minimal oversight
• Experience supervising and developing multidisciplinary teams, including responsibility for performance management and staff development
• Strong knowledge of healthcare delivery systems, clinical operations, and Medicaid policy structures
• Demonstrated ability to engage and advise senior leadership, state agencies, and external stakeholders
• Excellent analytical, problem-solving, and communication skills

The University of Illinois System is an equal opportunity employer, including but not limited to disability and/or veteran status, and complies with all applicable state and federal employment mandates. Please visit Required Employment Notices and Posters to view our non-discrimination statement and find additional information about required background checks, sexual harassment/misconduct disclosures, and employment eligibility review through E-Verify.

The university provides accommodations to applicants and employees. Request an Accommodation

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.