Top 18 Utilization review Jobs in Lincoln Ne

Medicaid Medical Director
Nebraska Department of Health and Human Services —Lincoln, NE
- $300,000 - $350,000 a year
- Full-time
- Medicine
- Doctoral degree
- BC/BE
- Health insurance
- Dental insurance
Quick Apply
Utilization Specialist
Lutheran Family Services —Lincoln, NE
- Full-time
- Hybrid work
- Master of Social Work
- Nursing
- RN License
Quick Apply
RN Care Manager
P3 Health Partners —Lincoln, NE
- $85,000 - $105,000 a year
- Hybrid work
- CPR Certification
- Nursing
- RN License
Quick Apply
2d
Utilization Management Manager
Bryan Health —Lincoln, NE
- Full-time
- CPR Certification
- Nursing
- RN License
Health Advocate - PRN
Lincoln Surgical Hospital —Lincoln, NE
- PRN
- RN License
- Hospital
- BLS Certification
Quick Apply
Care Transitions RN
Bryan Health —Lincoln, NE
- Full-time
- CPR Certification
- RN License
- Hospital
Medicaid Medical Director
State of Nebraska —Lincoln, NE
- $300,000 - $350,000 a year
- Full-time
- Medicine
- BC/BE
- Travel
- Health insurance
- Paid time off
Nursing Supervisor
Lincoln Medical Education Partnership —Lincoln, NE
- Full-time
- Nursing
- RN License
- BLS Certification
1d
Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)
UT Health Science Center at San Antonio —United States
- Hospital
- Outpatient experience
- 3 years
Quick Apply

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Utilization Specialist
Lutheran Family Services —Lincoln, NE
Valid driver’s license, liability auto insurance, and ability to drive a personal vehicle for travel between office locations and/or program sites, as needed.
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Residential Rehabilitation Specialist 1
Community Alliance —Omaha, NE
Possession of valid driver's license and good driving record, or ability to arrange for reliable transportation.
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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
4d
Specialist, Utilization Review
Columbus Springs East —Columbus, OH
License: Current unencumbered clinical license strongly preferred. UR contacts external case managers/managed care organizations for certification of insurance…
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Medicaid Medical Director

Nebraska Department of Health and Human Services -
Lincoln, NE

Quick Apply

Job Details

Full-time
$300,000 - $350,000 a year

Benefits

Health insurance
Dental insurance
Flexible spending account
Tuition reimbursement
Paid time off
Parental leave
Employee assistance program
Vision insurance
Employee discount
Professional development assistance
Life insurance
Retirement plan

Qualifications

Doctor of Medicine
Doctoral degree
Clinical program policy development
Managed care organization experience
Team leadership
BC/BE
Medicaid health insurance
Medical License
Medicaid regulations
Medicaid
Clinical team leadership
Healthcare policy implementation
Policy Development
Senior leadership
Quality assurance experience within healthcare

Full Job Description

Job Overview
The Nebraska Department of Health and Human Services (DHHS) is seeking an experienced physician leader to serve as Medical Director for the Division of Medicaid and Long-Term Care (MLTC). As the division's senior clinical executive, the Medical Director provides strategic clinical leadership for Nebraska's Medicaid program, ensuring the delivery of high-quality, evidence-based, and fiscally responsible healthcare services for Medicaid members across the state.

The Medical Director provides clinical oversight for Nebraska's Medical Assistance Program, including fee-for-service, managed care, waiver, and other healthcare delivery models. This position leads clinical quality strategy, medical policy, utilization management, and population health initiatives while serving as the principal physician advisor to MLTC executive leadership.

In addition to leading Medicaid clinical operations, the Medical Director will provide executive oversight for clinical initiatives associated with Nebraska's Rural Health Transformation Program (RHTP), supporting statewide efforts to improve access, care coordination, population health, and value-based care.

As a member of the MLTC Executive Leadership Team, the Medical Director serves as a trusted advisor to agency leadership, represents DHHS with providers, managed care organizations, legislators, and federal partners, and helps shape the future of Nebraska Medicaid.

Location: Preferred work location is Lincoln, Nebraska. Candidates located elsewhere in Nebraska will also be considered, with regular travel to Lincoln expected based on business needs.

Salary: Annual salary ranging from $300,000 - $350,000 commensurate with qualifications and experience, if approved. DHHS also offers a comprehensive benefits package, including health insurance, retirement, paid leave, and professional development opportunities.

Examples of Work:

Serve as the senior clinical leader for Nebraska Medicaid, providing strategic oversight of clinical operations, medical policy, quality improvement, utilization management, pharmacy, credentialing, and other medically related programs across fee-for-service, managed care, waiver, and other healthcare delivery models.
Lead the development and implementation of evidence-based clinical strategies that improve healthcare quality, patient safety, population health, value-based care, and health outcomes while ensuring compliance with federal and state Medicaid requirements.
Provide clinical leadership for Medicaid-related RHTP initiatives, advancing innovative care delivery models, whole-person care, and long-term system transformation that improve access and outcomes for Nebraskans.
Serve as the division's principal physician advisor to executive leadership, providing clinical expertise on healthcare policy, regulatory matters, legislative initiatives, complex medical determinations, and strategic planning.
Represent Nebraska Medicaid in collaboration with providers, Medicaid Managed Care Organizations, CMS, professional organizations, state agencies, and other stakeholders to strengthen partnerships, improve care coordination, and advance statewide quality initiatives.
Ensure the clinical integrity of Nebraska Medicaid through oversight of medical policy, quality initiatives, clinical program performance, medically related contracts, and other administrative or legal matters requiring physician expertise.

Minimum Qualifications:

Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO).
Active, unrestricted Nebraska medical license or ability to obtain prior to employment.
Board certification in a recognized specialty.
Progressive physician leadership experience within a healthcare organization, health plan, or public healthcare system.
Experience with Medicaid, managed care, healthcare quality improvement, and healthcare policy.
Demonstrated ability to lead complex clinical initiatives and build collaborative partnerships with providers, executive leadership, legislators, and regulatory agencies.

Job Type: Full-time

Pay: $300,000.00 - $350,000.00 per year

Benefits:

Dental insurance
Employee assistance program
Employee discount
Flexible spending account
Health insurance
Life insurance
Paid time off
Parental leave
Professional development assistance
Retirement plan
Tuition reimbursement
Vision insurance

Education:

Doctorate (Preferred)

License/Certification:

Medical License (Preferred)

Ability to Relocate:

Lincoln, NE 68508: Relocate before starting work (Required)

Work Location: In person

Quick Apply

Refine Your Search

utilization review jobs in lincoln ne

Medicaid Medical Director

Utilization Specialist

RN Care Manager

Utilization Management Manager

Health Advocate - PRN

Care Transitions RN

Medicaid Medical Director

Nursing Supervisor

Hospital - Clinical Pharmacist Specialist (Bone Marrow Transplant)

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