Opportunity Description
Job Summary
Location: Pennsylvania (onsite/hybrid/remote with periodic in state travel) Reports to: Chief Medical Officer Department: Health Services / Medical Management FLSA: Exempt | Employment Type: Full time
Job Duties
Role Summary
Lead clinical strategy, medical management, and regulatory performance for our Medicaid line of business across Pennsylvania (and any adjacent markets we enter). Partner with Quality, Utilization Management, Case/Disease Management, Pharmacy, Behavioral Health, Provider Network, and Compliance to deliver high‑quality, cost‑effective care and strong outcomes for Medicaid members. Serve as the primary physician liaison with the state Medicaid agency and key provider partners, and ensure contractual and regulatory compliance.
Key Responsibilities
Clinical leadership & Medicaid program oversight
+ Provide clinical direction for the Medicaid product, including medical policy, clinical guidelines,...
Location: Pennsylvania (onsite/hybrid/remote with periodic in state travel) Reports to: Chief Medical Officer Department: Health Services / Medical Management FLSA: Exempt | Employment Type: Full time
Job Duties
Role Summary
Lead clinical strategy, medical management, and regulatory performance for our Medicaid line of business across Pennsylvania (and any adjacent markets we enter). Partner with Quality, Utilization Management, Case/Disease Management, Pharmacy, Behavioral Health, Provider Network, and Compliance to deliver high‑quality, cost‑effective care and strong outcomes for Medicaid members. Serve as the primary physician liaison with the state Medicaid agency and key provider partners, and ensure contractual and regulatory compliance.
Key Responsibilities
Clinical leadership & Medicaid program oversight
+ Provide clinical direction for the Medicaid product, including medical policy, clinical guidelines,...
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