[Hiring] Director of Medicaid Clinical Programs @Alliant Health Solutions, Inc.

Role Description

Join Alliant Health Solutions as Director of Medicaid Clinical Programs and help advance access, quality, and outcomes.

The Director, Medicaid Clinical Programs provides clinical and operational leadership across Alliant’s Medicaid contracts and programs. The role oversees contract-specific functions that may include:

• Prior authorization
• Utilization and clinical review
• Quality improvement
• Compliance
• Provider oversight
• Claims review
• Program integrity

Using clinical expertise, process improvement methods, and data analysis, the Director:

• Identifies risks and opportunities
• Translates requirements and findings into practical interventions
• Improves access, quality, efficiency, compliance, and outcomes

The Director partners with clinical, programming, analytics, technology, and operations leaders to establish sustainable workflows.

Qualifications

• Strong knowledge of team leadership, prior authorization, clinical review workflows, medical necessity criteria, and applicable regulatory and accreditation requirements.
• Broad knowledge of Medicaid clinical and operational functions, including utilization management, quality improvement, compliance, provider oversight, claims analysis, program integrity, state Medicaid policy, FFS, and managed care.
• Knowledge of process and quality improvement methodologies.
• Ability to apply clinical knowledge and sound judgment.
• Excellent communication, interpersonal, facilitation, presentation, and critical-thinking skills.
• Ability to lead cross-functional teams and manage concurrent projects.
• Proficiency with Microsoft Word, PowerPoint, and Excel.
• Valid driver’s license and ability to travel by car or airplane.

Requirements

• Bachelor’s degree in nursing, public health, health administration, or a related field from an accredited college or university.
• Seven (7) to ten (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 relevant areas.
• Demonstrated success leading measurable process improvements.
• Strong understanding of healthcare quality measurement and improvement methodologies.

Benefits

• Meaningful impact in advancing access, quality, and outcomes.
• Opportunity to work in a recognized organization among Atlanta’s Best Places to Work and Healthiest Employers.

Physical Requirements

• Essential duties are routinely performed in a professional office environment but may be conducted in remote or field locations.
• Role may require work at a station/desk and routinely requires use of standard office equipment.
• Duties may require use of transportation to attend meetings or conduct duties outside of the office environment.
• Must be able to regularly remain in a stationary position and occasionally move around the office.
• Occasionally must be able to move/transport materials weighing up to 30 pounds.
• Frequent communication with internal and external resources both verbally and written.

ADA/ADAAA/Section 503 Notification

In compliance with the ADA, the ADA Amendments Act (ADAAA) and Section 503 of the Rehabilitation Act, should you have a disability and would like to request a reasonable accommodation, please see Human Resources to begin the interactive process.

Disclaimer

This job description indicates the general nature and level of work expected of the incumbent. It is designed to cover or contain a comprehensive, but not all-inclusive, listing of activities, duties or responsibilities required of the incumbent. Incumbent may be asked to perform other duties as required.