Director, Medicaid Clinical Programs

Job overview

The Director, Medicaid Clinical Programs works onsite in Florence, SC; compensation is not specified. Alliant Health Solutions provides clinical and operational support across Medicaid contracts and programs, with a focus on improving access, quality, efficiency, compliance, and outcomes. The director provides strategic and operational leadership for assigned Medicaid program functions. By analyzing clinical and operational data, guiding improvement initiatives, and coordinating across clinical, analytics, technology, and operations teams, the role helps deliver compliant and effective program services.

What you'll do

• Lead analysis of clinical, operational, claims, quality, and performance data
• provide oversight and expertise for prior authorization and clinical operations
• lead contract-specific provider reviews, education, utilization and compliance reviews, claims review, and program integrity coordination as required
• partner with analytics teams on measures and dashboards
• lead process and quality improvement
• prepare reports and presentations
• collaborate across teams to implement compliant processes
• maintain knowledge of Medicaid requirements and delivery models.

What we're looking for

Skills & competencies

director

medicaid clinical programs

full-time

florence sc

alliant health solutions

medicaid

prior authorization

utilization management

quality improvement

clinical operations

claims review

data analysis

Work arrangement

• Weekend coverage required

Why this role

Requires a bachelor’s degree in nursing, public health, health administration, or a related field and seven to ten years of healthcare experience, including prior authorization, utilization review/management, or comparable clinical review operations. Travel to customer locations and meetings may be needed.

About the employer

Alliant Health Solutions, Inc. is hiring for this role. Industry: Administration of Public Health Programs. Sector: 92.