Medical Director – Medicaid

Geisinger

Medical Director overseeing Medicaid clinical strategy and management across Pennsylvania. Collaborating with multiple teams to ensure high-quality, cost-effective care for Medicaid members.

Posted 5/28/2026full-timePennsylvania • 🇺🇸 United StatesLeadWebsite

About the role

Key responsibilities & impact

Lead clinical strategy, medical management, and regulatory performance for Medicaid line of business across Pennsylvania
Partner with Quality, Utilization Management, Case/Disease Management, Pharmacy, Behavioral Health, Provider Network, and Compliance to deliver high‑quality, cost‑effective care
Serve as primary physician liaison with state Medicaid agency and key provider partners
Provide clinical direction for Medicaid product, including medical policy, clinical guidelines, and care model design across UM/CM/DM
Ensure determinations are clinically sound and timely
Oversee grievance and appeals clinical reviews and author evidence‑based rationales
Drive quality improvement, close gaps in care, and monitor outcomes and utilization trends
Serve as clinical liaison to hospitals, systems, and practices; educate on medical policies/criteria
Collaborate with Provider Network on value‑based models, performance feedback, appeals resolution themes, and market growth priorities
Act as the plan’s clinical spokesperson with state Medicaid agency and advisory bodies

Requirements

What you’ll need

MD or DO , board certified (ABMS/AOA)
Active Pennsylvania medical license or eligibility to obtain PA licensure within 6 months of hire
5–7+ years clinical practice plus 3+ years in a health‑plan medical leadership role (Medical Director or Deputy) specific to Medicaid
Demonstrated experience with utilization management, appeals/grievances, and medical policy in a managed care setting
Working knowledge of NCQA/URAC standards and state Medicaid regulatory requirements; familiarity with CMS expectations for managed care
Must primarily reside in PA and have a home address in PA or willing to relocate

Benefits

Comp & perks

healthcare benefits for full-time and part-time positions from day one
vision, dental and domestic partners
atmosphere of collaboration, cooperation and collegiality

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

clinical strategymedical managementregulatory performanceutilization managementmedical policyclinical guidelinescare model designquality improvementevidence-based rationalevalue-based models

Soft Skills

leadershipcollaborationcommunicationeducationclinical liaison

Certifications

MDDOboard certified (ABMS/AOA)active Pennsylvania medical license