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 lon
• 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