Medicaid Medical Director

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.

Pay

Annual salary ranging from $300,000 - $350,000 commensurate with qualifications and experience, if approved.

Benefits

Includes a comprehensive benefits package, including health insurance, retirement, paid leave, and professional development opportunities.

Schedule

Regular travel to Lincoln expected based on business needs.

Location

Preferred work location is Lincoln, Nebraska. Candidates located elsewhere in Nebraska will also be considered.

Reports to

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