Medical Director

Equity Staffing is seeking an experienced LTSS Medical Director to provide clinical leadership and oversight for the Tennessee Long-Term Services and Supports (LTSS) population. This role is responsible for utilization management, quality initiatives, and collaboration across clinical teams to ensure high-quality, cost-effective care for members. Key Responsibilities Perform daily medical necessity reviews for home and community-based services; approve or deny services based on clinical criteria Collaborate with nursing and care management teams to clarify service requests and documentation Represent the health plan in Board of Hearing cases and external reviews Oversee utilization management activities and monitor outcomes of care management and health services interventions Partner with behavioral health and clinical teams to support a fully integrated care model Support and lead clinical quality initiatives, peer reviews, and performance improvement projects Serve as a clinical resource and coach to internal teams, supporting health plan goals and programs Collaborate with the Chief Medical Officer and cross-functional leadership to achieve market and national objectives Build and maintain strong relationships with network providers and community physicians Assist in the development and implementation of clinical policies, procedures, and quality improvement strategies Analyze clinical data and key metrics to drive performance and improve outcomes Required Qualifications Active, unrestricted Physician license Board Certification in an ABMS or AOBMS specialty 5+ years of clinical practice experience Strong knowledge of managed care and Medicaid, specifically LTSS 2-3 years of quality management experience Proficiency with Microsoft Office applications Preferred Skills & Attributes Strong leadership and team-building capabilities in a matrixed environment Excellent interpersonal and communication skills (clinical and non-clinical audiences) Proven ability to build relationships with providers and stakeholders Strong project management and organizational skills Data-driven mindset with the ability to analyze and interpret key metrics Strategic thinker with the ability to drive results and influence outcomes Effective negotiation, conflict resolution, and problem-solving skills Equity Staffing Group is an Equal Opportunity Employer and considers all qualified applicants in accordance with applicable employment laws. #J-18808-Ljbffr