State Medicaid Medical Director

State of Nebraska•Lincoln, NE

5d•$300,000 - $350,000•Hybrid

About The Position

The Nebraska Department of Health and Human Services (DHHS) is seeking an experienced physician leader to serve as Medical Director for the Division of Medicaid and Long-Term Care (MLTC). As Nebraska Medicaid's senior physician leader, the Medical Director provides strategic leadership and oversight of the clinical and medical management functions of a statewide Medicaid payer, supporting healthcare coverage and services delivered through managed care, fee-for-service, waiver, and other delivery models. This role requires a physician leader who understands healthcare from both the clinical and payer perspective. The Medical Director provides oversight and direction across medical policy, utilization management, quality, pharmacy, credentialing, population health, and other clinical functions, balancing evidence-based care, member access, quality outcomes, regulatory requirements, and responsible stewardship of Medicaid resources. The Medical Director serves as the principal physician advisor to MLTC leadership and works closely with Nebraska's Medicaid managed care organizations, providers, CMS, and other partners to evaluate healthcare utilization and outcomes, establish clinical policy and strategy, improve quality and access, and support the long-term sustainability of Nebraska's Medicaid program. The position also provides physician leadership for Medicaid-related initiatives within Nebraska's Rural Health Transformation Program (RHTP), helping connect broader healthcare transformation efforts with Medicaid payment, quality, access, and delivery-system strategies. As a member of the MLTC Executive Leadership Team, the Medical Director serves as a trusted advisor to agency leadership and helps shape clinical and healthcare policy affecting Nebraska Medicaid members statewide.

Requirements

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) and an active, unrestricted Nebraska medical license or ability to obtain prior to employment.
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.

Nice To Haves

Physician leadership experience within a state Medicaid program, Medicaid managed care organization, health plan, or other government-sponsored healthcare program, or commercial health insurance.
Experience providing leadership or oversight of payer clinical functions such as utilization management, medical policy, quality, pharmacy, credentialing, population health, or value-based care.
Experience using claims, utilization, quality, cost, and population health data to inform clinical strategy, healthcare policy, and program performance.
Experience working with CMS, state Medicaid agencies, managed care organizations, or other government healthcare partners, including experience with healthcare payment or delivery-system transformation.
Experience and knowledge of care delivery in both an urban and highly rural healthcare setting

Responsibilities

Serve as the senior physician leader for Nebraska Medicaid, providing strategic oversight of payer-side clinical and medical management functions, including medical policy, utilization management, quality improvement, pharmacy, credentialing, population health, and other medically related programs across managed care, fee-for-service, waiver, and other healthcare delivery models.
Use healthcare utilization, quality, cost, pharmacy, and population health data to identify trends, evaluate clinical performance, inform policy and benefit decisions, and develop strategies that improve outcomes while supporting responsible stewardship of Medicaid resources.
Partner with Medicaid managed care organizations to provide clinical oversight, evaluate performance, address emerging quality or utilization concerns, and ensure alignment with Nebraska Medicaid's clinical priorities and contractual expectations.
Lead the development and implementation of evidence-based clinical strategies that improve healthcare quality, member outcomes, 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.