Medicaid Clinical Programs Leader: Access & Quality Impact

Alliant Health Group; Columbia (SC); On-site; USD 140,000 - 190,000; Full time

Job summary

Alliant Health Solutions in Columbia, SC seeks a Director of Medicaid Clinical Programs to drive clinical and operational leadership across Medicaid contracts and programs. You will oversee prior authorization, utilization review, quality improvement, and compliance initiatives, translating data into actionable interventions and scalable workflows across analytics, technology, and operations teams.

The role requires deep Medicaid knowledge, strategic thinking, and the ability to lead

Qualifications

• Bachelor's degree in nursing, public health, health administration, or related field.
• 7–10 years of healthcare experience, including prior authorization, utilization review or management, or comparable clinical review operations.
• Experience supporting multiple Medicaid programs or contracts in one or more relevant areas, including clinical review, quality improvement, provider oversight, compliance, claims review, or healthcare program integrity.
• Demonstrated success leading measurable process improvements and using clinical and operational data to establish priorities, guide action, and evaluate results.
• Strong understanding of healthcare quality measurement and improvement methodologies and demonstrated ability to lead and collaborate across clinical, analytics, technology, and operations teams.

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 and subject matter expertise for prior authorization and related clinical operations, including medical necessity criteria, review workflows, timeliness, quality, regulatory and accreditation compliance, provider and member experience, and operational performance.
• Lead contract-specific clinical and operational activities, including provider reviews and education, corrective-action follow-up, utilization and compliance reviews, claims review, provider oversight, and program integrity coordination, as required by assigned contracts.
• Partner with analytics teams to translate data into actionable priorities, interventions, dashboards, measures, and analytic products; monitor results and adjust improvement strategies.
• Lead process and quality improvement initiatives from assessment through implementation and monitoring to improve workflow reliability, turnaround times, clinical consistency, and outcomes.
• Develop clear reports, recommendations, and presentations for executives, customers, state Medicaid agencies, and other stakeholders.
• Collaborate with clinical, program, analytics, technology, and operations leaders to implement scalable, repeatable, and compliant processes and apply current clinical standards to program design, implementation, and evaluation.
• Maintain current knowledge of Medicaid requirements and delivery models, including FFS and managed care, relevant to assigned programs, customers, and contracts.
• Partner with Program Directors, the Medical Director, and the Chief Operating Officer on new business opportunities and organizational initiatives.
• Perform other duties as assigned.

Skills

Leadership

Prior authorization

Clinical review

Medicaid knowledge

Data analysis

Education

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

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

National quality certification

Tools

Microsoft Word

PowerPoint

Excel

Job description

Alliant Health Solutions in Columbia, SC seeks a Director of Medicaid Clinical Programs to drive clinical and operational leadership across Medicaid contracts and programs. You will oversee prior authorization, utilization review, quality improvement, and compliance initiatives, translating data into actionable interventions and scalable workflows across analytics, technology, and operations teams.

The role requires deep Medicaid knowledge, strategic thinking, and the ability to lead