Medicaid Clinical Programs Director - Impact & Quality

Alliant Health Group; Dunwoody (GA); On-site; USD 150,000 - 190,000; Full time

Job summary

Alliant Health Solutions seeks a Director of Medicaid Clinical Programs to lead clinical and operational efforts across Medicaid contracts, driving access, quality, and outcomes. This role shapes medical necessity criteria, reviews workflows, and ensures compliance while guiding analytics, program integrity, and provider oversight.

You will collaborate with executives and cross-functional leaders to implement scalable processes, manage performance, and advance Medicaid programs including FFS and

Qualifications

• Bachelor's degree in nursing, public health, health administration, or a related field.
• Seven to ten years of healthcare experience including prior authorization, utilization review, or clinical review operations.
• Experience with Medicaid programs or contracts including clinical review, quality improvement, provider oversight, compliance, claims review, or program integrity.

Responsibilities

• Lead analysis of clinical, operational, claims, quality, and performance data to identify trends, risks, compliance concerns, service gaps, and improvement opportunities across Medicaid programs.
• Provide strategic oversight for prior authorization and related clinical operations, including medical necessity criteria, review workflows, timeliness, quality, and regulatory compliance.
• Lead contract-specific clinical and operational activities, including provider reviews, corrective actions, utilization and compliance reviews, claims review, and program integrity coordination.
• Partner with analytics teams to translate data into actionable priorities, dashboards, and measures; monitor results and adjust strategies.
• Lead process and quality improvement initiatives from assessment through implementation and monitoring to improve workflow reliability and outcomes.
• Develop clear reports and presentations for executives, customers, state Medicaid agencies, and other stakeholders.
• Collaborate to implement scalable, compliant processes and apply current clinical standards to program design and evaluation.

Skills

Team leadership

Prior authorization

Clinical review workflows

Quality improvement

Regulatory compliance

Provider oversight

Claims analysis

Program integrity

Data analysis

Communication

Education

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

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, driving access, quality, and outcomes. This role shapes medical necessity criteria, reviews workflows, and ensures compliance while guiding analytics, program integrity, and provider oversight.

You will collaborate with executives and cross-functional leaders to implement scalable processes, manage performance, and advance Medicaid programs including FFS and