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
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