Medical Director

Job Description

Job Description

Job Title: LTSS Medical Director
Location: Tennessee
Reports To: Chief Medical Officer (CMO), UnitedHealthcare Community Plan of Tennessee

Contract : 06/2026- 09/2026

Position Overview

The LTSS Medical Director provides clinical leadership and oversight for the Long-Term Services and Supports (LTSS) population in Tennessee. Reporting directly to the Chief Medical Officer, this role is responsible for ensuring appropriate utilization of home and community-based services, supporting quality initiatives, and collaborating across clinical and operational teams to drive improved health outcomes.

Key Responsibilities

• Conduct daily reviews of home and community-based service requests to approve or deny services based on medical necessity and policy guidelines

• Partner with nursing staff to clarify service requests and ensure complete, accurate documentation

• Represent the health plan in Board of Hearing cases as a clinical expert

• Lead and support utilization management activities, including monitoring care management and health services interventions to ensure achievement of utilization goals

• Collaborate with Care Management, Behavioral Health, and other clinical teams to maintain alignment with performance targets

• Contribute to the development of a fully integrated clinical model across physical and behavioral health services

• Support clinical quality initiatives, peer review processes, and continuous improvement efforts

• Serve as a clinical resource and coach to internal teams, supporting organizational programs and strategic goals

• Partner with the Chief Medical Officer, clinical operations, and market leadership to meet both local and national clinical objectives

• Provide clinical leadership focused on home and community-based services, including external engagement with network physicians and providers

• Assist in the development and implementation of clinical policies, procedures, quality improvement initiatives, and performance improvement projects

Qualifications

• Active and unrestricted physician license

• Board Certification in an ABMS or AOBMS specialty

• Minimum of 5 years of clinical practice experience

• Strong knowledge of the managed care industry, with emphasis on Medicaid and LTSS populations

• 2–3 years of experience in quality management

• Familiarity with current medical practices, healthcare delivery models, and regulatory requirements

Core Competencies

• Demonstrated leadership ability with a track record of achieving results and building effective teams in a matrixed organization

• Excellent interpersonal and communication skills, with the ability to engage both clinical and non-clinical audiences

• Strong presentation and influencing skills

• Proven ability to develop and maintain relationships with network and community physicians and providers

• Effective project management capabilities

• Strong analytical skills with the ability to interpret data and focus on key performance metrics

• Strategic thinker with the ability to communicate vision and drive execution

• Skilled in negotiation and conflict resolution

• Creative problem-solving abilities

• Proficiency in Microsoft Office applications