Director, Clinical Review Team - Medicaid Advisory Unit (MAU)

University of Illinois Chicago•Chicago, IL

10d•Onsite

About The Position

The Director, Clinical Review Team serves in a senior leadership and advisory capacity within the Department of Medicine's Medicaid Advisory Unit (MAU), providing advanced clinical, analytical, and policy expertise to support the Illinois Department of Healthcare and Family Services (HFS). This position exercises a high degree of independent judgment and decision-making authority in the interpretation of complex clinical and Medicaid policy issues and the development of recommendations that influence statewide program design, utilization management strategies, and coverage determinations. The Director is responsible for leading the integration of clinical expertise into Medicaid policy development and program operations, overseeing a portfolio of complex clinical review initiatives, including prior authorization and utilization review programs. The role directs multidisciplinary teams, ensures the consistent application of clinical and policy standards, and advances strategic initiatives that enhance program efficiency, effectiveness, and quality. As a senior subject matter expert and institutional representative, the Director engages with HFS, the Office of Medicaid Innovation (OMI), and other governmental and external stakeholders, contributing to high-level policy discussions and cross-agency collaboration. This position has significant impact on program direction, operational performance, and the advancement of Medicaid clinical review strategies. This position performs work that is predominantly intellectual and requires the consistent exercise of discretion and independent judgment. The role is responsible for interpreting and developing clinical review workflows, providing expert consultation, and leading programs with significant institutional and statewide impact.

Requirements

Bachelor’s degree in nursing, public health, healthcare administration, or a related field
Seven (7) years of progressively responsible experience demonstrating advanced clinical, analytical, and program leadership expertise in healthcare, Medicaid programs, or policy-driven environments
Demonstrated experience leading complex, multi-program initiatives with significant operational, clinical, or policy impact
Proven ability to apply specialized knowledge to interpret, develop, and influence policy and program outcomes
Demonstrated experience exercising independent decision-making authority in complex, high-impact situations with minimal oversight
Experience supervising and developing multidisciplinary teams, including responsibility for performance management and staff development
Strong knowledge of healthcare delivery systems, clinical operations, and Medicaid policy structures
Demonstrated ability to engage and advise senior leadership, state agencies, and external stakeholders
Excellent analytical, problem-solving, and communication skills

Nice To Haves

Master’s degree in public health, healthcare administration, business administration, or a related field
Active Registered Nurse (RN) licensure or equivalent clinical credential
Experience advising or partnering with state Medicaid agencies or public-sector healthcare programs
Demonstrated experience developing and implementing healthcare policies, utilization management strategies, or large-scale program initiatives
Experience in population health, public health systems, or healthcare transformation initiatives
Experience leading teams in complex, high-stakes environments requiring rapid decision-making and cross-functional coordination
Familiarity with quality improvement methodologies and healthcare performance metrics

Responsibilities

Lead the strategic design, implementation, and oversight of clinical review programs and operational frameworks aligned with Medicaid policy, regulatory requirements, and organizational priorities.
Exercise a high degree of independent judgment in translating federal and state Medicaid policies into programmatic guidance, operational procedures, and clinical review standards.
Establish program goals, performance metrics, and quality benchmarks; evaluate outcomes and implement data-informed improvements.
Identify and lead strategic initiatives to enhance program performance, improve operational efficiencies, and support innovation across Medicaid clinical review activities.
Provide executive-level oversight of day-to-day operations across multiple complex programs, ensuring timely, accurate, and high-quality execution.
Independently assess, prioritize, and resolve complex clinical, operational, and policy-related issues with significant programmatic and stakeholder impact.
Develop, implement, and standardize workflows, protocols, and best practices to ensure consistency and quality across clinical review functions and multiple technical platforms.
Ensure compliance with all applicable federal and state regulations, contractual requirements, and internal policies.
Provide leadership and direction to a multidisciplinary team, including an Associate Director and program staff, with responsibility for hiring, onboarding, performance management, and staff development.
Establish clear performance expectations, accountability structures, and professional development pathways to support a high-performing and responsive team.
Mentor staff and cultivate advanced clinical, analytical, and policy expertise across the team.
Serve as a senior subject matter expert in healthcare operations and clinical review, providing guidance on complex cases, programmatic issues, and emerging healthcare practices.
Interpret and apply Medi