Medicaid Medical Director

Nebraska Department of Health and Human Services; Nebraska; On-site; USD 300,000 - 350,000; Full time

Job summary

Nebraska Department of Health and Human Services is seeking an experienced physician leader to serve as Medical Director for the Division of Medicaid and Long-Term Care. The Medical Director provides strategic clinical leadership to ensure high‑quality, evidence‑based care for Nebraska's Medicaid members.

As MLTC's principal physician advisor, the role directs clinical quality, medical policy, and population health initiatives, while helping shape value‑based care statewide and coordinating with

Qualifications

• MD or DO with Nebraska license or eligible to obtain one.
• Board certification in a recognized specialty.
• Progressive physician leadership experience in a health system or plan.
• Experience with Medicaid, managed care, and health policy.

Responsibilities

• Serve as the senior clinical leader for Nebraska Medicaid and related programs.
• Lead clinical quality strategy, policy, utilization management, and population health initiatives.
• Provide executive clinical oversight for Rural Health Transformation Program initiatives.
• Advise MLTC executive leadership on healthcare policy and strategic planning.
• Represent Nebraska Medicaid with providers, MCOs, CMS, and state partners.
• Ensure clinical integrity through medical policy oversight and quality initiatives.

Skills

Clinical leadership

Policy experience

Stakeholder collaboration

Medicaid/Managed care

Education

MD or DO

Job description

The Nebraska Department of Health and Human Services (DHHS) is seeking an experienced physician leader to serve as Medical Director for the Division of Medicaid and Long-Term Care (MLTC). As the division's senior clinical executive, the Medical Director provides strategic clinical leadership for Nebraska's Medicaid program, ensuring the delivery of high-quality, evidence-based, and fiscally responsible healthcare services for Medicaid members across the state.

The Medical Director provides clinical oversight for Nebraska's Medical Assistance Program, including fee-for-service, managed care, waiver, and other healthcare delivery models. This position leads clinical quality strategy, medical policy, utilization management, and population health initiatives while serving as the principal physician advisor to MLTC executive leadership.

In addition to leading Medicaid clinical operations, the Medical Director will provide executive oversight for clinical initiatives associated with Nebraska's Rural Health Transformation Program (RHTP), supporting statewide efforts to improve access, care coordination, population health, and value-based care.

As a member of the MLTC Executive Leadership Team, the Medical Director serves as a trusted advisor to agency leadership, represents DHHS with providers, managed care organizations, legislators, and federal partners, and helps shape the future of Nebraska Medicaid.

Location: Preferred work location is Lincoln, Nebraska. Candidates located elsewhere in Nebraska will also be considered, with regular travel to Lincoln expected based on business needs.

Salary: Annual salary ranging from $300,000 - $350,000 commensurate with qualifications and experience, if approved. DHHS also offers a comprehensive benefits package, including health insurance, retirement, paid leave, and professional development opportunities.

Reports to: Drew Gonshorowski, Director, Division of Medicaid and Long-Term Care.

Primary Responsibilities:

• Serve as the senior clinical leader for Nebraska Medicaid, providing strategic oversight of clinical operations, medical policy, quality improvement, utilization management, pharmacy, credentialing, and other medically related programs across fee-for-service, managed care, waiver, and other healthcare delivery models.
• Lead the development and implementation of evidence-based clinical strategies that improve healthcare quality, patient safety, population health, value-based care, and health outcomes while ensuring compliance with federal and state Medicaid requirements.
• Provide clinical leadership for Medicaid-related RHTP initiatives, advancing innovative care delivery models, whole-person care, and long-term system transformation that improve access and outcomes for Nebraskans.
• Serve as the division's principal physician advisor to executive leadership, providing clinical expertise on healthcare policy, regulatory matters, legislative initiatives, complex medical determinations, and strategic planning.
• Represent Nebraska Medicaid in collaboration with providers, Medicaid Managed Care Organizations, CMS, professional organizations, state agencies, and other stakeholders to strengthen partnerships, improve care coordination, and advance statewide quality initiatives.
• Ensure the clinical integrity of Nebraska Medicaid through oversight of medical policy, quality initiatives, clinical program performance, medically related contracts, and other administrative or legal matters requiring physician expertise.

Requirements/Qualifications:

Minimum Qualifications:

• Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
• Active, unrestricted Nebraska medical license or ability to obtain prior to employment.
• Board certification in a recognized specialty.
• Progressive physician leadership experience within a healthcare organization, health plan, or public healthcare system.
• Experience with Medicaid, managed care, healthcare quality improvement, and healthcare policy.
• Demonstrated ability to lead complex clinical initiatives and build collaborative partnerships with providers, executive leadership, legislators, and regulatory agencies.