Head of Medicaid Clinical Programs

Alliant Health Group; Atlanta (GA); On-site; USD 180,000 - 250,000; Full time

Job summary

Alliant Health Solutions seeks a Director of Medicaid Clinical Programs to lead clinical and operational efforts across Medicaid contracts, focusing on access, quality, and outcomes. You will drive strategic oversight of prior authorization, utilization review, and program integrity while guiding cross-functional teams.

Based in Atlanta, this role partners with executives to translate data into actionable improvements, develop scalable workflows, and ensure regulatory compliance across FFS and

Qualifications

• Bachelor's degree in nursing, public health, health administration, or a related field; seven to ten years healthcare experience in relevant areas.
• Strong knowledge of Medicaid quality measurement and improvement methodologies and demonstrated ability to lead across clinical, analytics, technology, and operations teams.
• Excellent communication and presentation skills with ability to engage executive, customer, and large-group audiences.

Responsibilities

• Lead analysis of clinical, operational, claims, quality, and performance data to identify trends, risks, compliance concerns, service gaps, root causes, and improvement opportunities across Medicaid programs.
• Provide strategic oversight for prior authorization and related clinical operations, including medical necessity criteria and review workflows.
• Lead contract-specific clinical and operational activities, including provider reviews, corrective actions, utilization and compliance reviews, and program integrity coordination.
• Partner with analytics teams to translate data into actionable priorities, interventions, dashboards, measures, and analytic products.
• Lead process and quality improvement initiatives from assessment through implementation and monitoring to improve workflow reliability and outcomes.
• Develop clear reports, recommendations, and presentations for executives, customers, state Medicaid agencies, and other stakeholders.

Skills

Team leadership

Prior authorization

Clinical review

Regulatory compliance

Data analysis

Communication skills

Presentation skills

Project management

Travel

Education

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

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

National quality certification

Tools

Microsoft Word

PowerPoint

Excel

Job description

Alliant Health Solutions seeks a Director of Medicaid Clinical Programs to lead clinical and operational efforts across Medicaid contracts, focusing on access, quality, and outcomes. You will drive strategic oversight of prior authorization, utilization review, and program integrity while guiding cross-functional teams.

Based in Atlanta, this role partners with executives to translate data into actionable improvements, develop scalable workflows, and ensure regulatory compliance across FFS and