Associate Director, Clinical Review Team (MAU)

University of Illinois Chicago•Chicago, IL

10d•Onsite

About The Position

The Associate Director provides strategic, operational, and clinical leadership for the Clinical Review Team within the Medicaid Advisory Unit (MAU) in the Department of Medicine at the University of Illinois Chicago. This role exercises a high level of independent judgment in the development, implementation, and oversight of clinical review operations, program workflows, and policy-aligned initiatives supporting the Illinois Medicaid program. Reporting to the Director, the Associate Director serves as a key leader responsible for translating complex Medicaid policies into actionable clinical and operational processes. The position directs program activities across multiple service lines, ensures consistency and quality in clinical review standards, and drives continuous process improvement. The Associate Director also serves as a primary liaison with internal leadership, state agency partners, and external stakeholders, and is accountable for program performance, compliance, and staff management. This position may act on behalf of the Director in assigned areas of responsibility.

Requirements

Bachelor’s degree in healthcare administration, public health, nursing, clinical laboratory science, or a related field
Minimum of five (5) years of progressively responsible experience in healthcare operations, clinical program management, utilization review, or a related area
Demonstrated experience leading programs, projects, or operational initiatives with independent decision-making authority
Experience supervising staff and managing team performance
Strong analytical and problem-solving skills, including the ability to interpret complex policies and apply them in operational settings
Experience working with healthcare data, reporting, and performance metrics
Excellent communication skills, including the ability to engage effectively with internal and external stakeholders

Nice To Haves

Master’s degree in healthcare administration (MHA), public health (MPH), business administration (MBA), or a related field
Clinical credential (e.g., RN, MLS, or equivalent) or significant clinical operations experience
Experience with Medicaid policy, reimbursement structures, and/or utilization management
Experience working with or supporting state agencies or large healthcare systems
Experience managing multi-functional teams or complex program portfolios

Responsibilities

Lead the design, implementation, and ongoing management of clinical review programs and operational workflows aligned with Medicaid policy and organizational priorities
Establish program goals, performance metrics, and quality standards; monitor outcomes and implement improvements as needed
Identify strategic opportunities for process enhancement and operational efficiencies across programs
Direct day-to-day program operations across multiple initiatives, ensuring timely, high-quality execution
Independently evaluate and resolve complex clinical, operational, and policy-related issues
Develop and implement standardized workflows and protocols to ensure consistency across clinical review activities
Ensure compliance with regulatory requirements and internal policies
Provide additional supervision to clinical, administrative, and/or program staff, including onboarding, performance management, and professional development, as delegated by the Director.
Establish clear expectations and accountability structures to ensure high performance and responsiveness
Mentor staff and support the development of subject matter expertise across the team
Serve as a subject matter expert in healthcare operations and clinical review, providing guidance on complex cases and programmatic questions
Interpret and apply Medicaid policies, reimbursement methodologies, and utilization review standards
Provide recommendations to leadership on policy implications, program direction, and operational considerations
Maintain regular contact and visibility with state agencies (e.g., HFS), clinical partners, and other stakeholders
Lead or participate in meetings with external entities to represent programmatic interests and provide expert guidance
Facilitate alignment across clinical, administrative, and policy stakeholders
Oversee data analysis, reporting, and performance tracking to inform decision-making and program improvements
Lead quality assurance and continuous improvement initiatives
Ensure effective use of data systems and reporting tools to support program operations
Perform other related duties and participate in special projects as assigned.