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 ResponsibilitiesPerform daily medical necessity reviews for home and community-based services; approve or deny services based on clinical criteriaCollaborate with nursing and care management teams to clarify service requests and documentationRepresent the health plan in Board of Hearing cases and external reviewsOversee utilization management activities and monitor outcomes of care management and health services interventionsPartner with behavioral health and clinical teams to support a fully integrated care modelSupport and lead clinical quality initiatives, peer reviews, and performance improvement projectsServe as a clinical resource and coach to internal teams, supporting health plan goals and programsCollaborate with the Chief Medical Officer and cross-functional leadership to achieve market and national objectivesBuild and maintain strong relationships with network providers and community physiciansAssist in the development and implementation of clinical policies, procedures, and quality improvement strategiesAnalyze clinical data and key metrics to drive performance and improve outcomesRequired QualificationsActive, unrestricted Physician licenseBoard Certification in an ABMS or AOBMS specialty5+ years of clinical practice experienceStrong knowledge of managed care and lon2-3 years of quality management experienceProficiency with Microsoft Office applicationsPreferred Skills & AttributesStrong leadership and team-building capabilities in a matrixed environmentExcellent interpersonal and communication skills (clinical and non-clinical audiences)Proven ability to build relationships with providers and stakeholdersStrong project management and organizational skillsData-driven mindset with the ability to analyze and interpret key metricsStrategic thinker with the ability to drive results and influence outcomesEffective negotiation, conflict resolution, and problem-solving skills