Medicaid Clinical Programs Director: Quality & Access

Alliant Health Group; Brooklyn Heights (TN); Presencial; USD 160.000 - 210.000; Jornada completa

Descripción de la vacante

Alliant Health Solutions is seeking a Director of Medicaid Clinical Programs to drive clinical and operational leadership across Medicaid contracts. You will oversee prior authorization, utilization and quality initiatives, and program integrity, translating data into practical improvements and scalable workflows.

Collaborate with analytics, technology, and operations leaders to advance access, quality, and outcomes while maintaining regulatory compliance. Travel to partner sites may be required.

Formación

• Bachelor's degree in nursing, public health, health administration, or a related field is required.
• 7–10 years of healthcare experience including prior authorization, utilization review, or similar clinical operations.
• Experience supporting multiple Medicaid programs or contracts in relevant areas such as quality improvement or program integrity.
• Demonstrated success leading measurable process improvements using clinical and operational data.

Responsabilidades

• Lead analysis of clinical, operational, claims, quality, and performance data to identify trends and improvement opportunities across Medicaid programs.
• Provide strategic oversight for prior authorization and related clinical operations, including medical necessity criteria and workflow quality.
• Lead contract-specific clinical and operational activities, including provider reviews and education, and compliance oversight.
• Partner with analytics to translate data into priorities, dashboards, and analytic products; monitor results and adjust strategies.
• Lead quality improvement initiatives from assessment through implementation and monitoring to improve reliability and outcomes.

Conocimientos

Team leadership

Prior authorization

Clinical review workflows

Regulatory compliance

Educación

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

7–10 years healthcare experience

Experience with Medicaid programs or contracts

Herramientas

Microsoft Word

PowerPoint

Excel

Descripción del empleo

Alliant Health Solutions is seeking a Director of Medicaid Clinical Programs to drive clinical and operational leadership across Medicaid contracts. You will oversee prior authorization, utilization and quality initiatives, and program integrity, translating data into practical improvements and scalable workflows.

Collaborate with analytics, technology, and operations leaders to advance access, quality, and outcomes while maintaining regulatory compliance. Travel to partner sites may be required.