Medical Director

About the Role We are seeking an experienced and compassionate Medical Director (LTSS) to support the Tennessee Long-Term Services & Supports (LTSS) population. In this role, you will provide clinical leadership, oversee utilization management, and collaborate cross-functionally to optimize member care, quality outcomes, and operational performance. You will work closely with care management, behavioral health, and clinical operations teams to build an integrated care model that improves the health and well-being of our members. What You’ll Do Conduct daily clinical reviews of home and community-based services; approve or deny services based on medical necessity. Collaborate with nursing and care management teams to ensure accurate documentation and clarify service requests. Represent the health plan in Board of Hearing proceedings. Minimum Qualifications Active and unrestricted Physician license. Board Certification (ABMS or AOBMS recognized specialty). 5+ years of clinical practice experience. Experience in managed care and Medicaid (LTSS preferred). 2–3 years of experience in quality management or utilization review. Strong understanding of current medical practices and healthcare trends. Demonstrated leadership experience in a matrixed organization. Equal Employment Opportunity (EEO) Statement We are an Equal Opportunity Employer and value diversity at our organization. We do not discriminate on the basis of race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, veteran status, or any other protected characteristic in accordance with applicable laws. We are committed to creating an inclusive environment for #J-18808-Ljbffr