Associate Medical Director - Community & State - Florida

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The Associate Medical Director for UnitedHealthcare Community & State Florida is an important clinical leadership role focused on improving quality, supporting thoughtful medical decision-making, and enhancing the member and provider experience across Medicaid, D-SNP, and LTC populations.

Working closely with the Chief Medical Officer and cross-functional partners, this role offers the opportunity to shape utilization management, quality improvement, provider collaboration, and population health efforts while helping ensure alignment with the Florida Agency for Health Care Administration (AHCA) requirements and applicable state and federal regulations.

Reporting Structure

• Reports to: Chief Medical Officer, Community & State Florida
• Works closely with: Quality, Population Health, Provider Engagement, and Operations leaders

Work Location

• Florida-based role with remote flexibility
• Occasional in-state travel may be required
• Remote employees must follow UnitedHealth Group's Telecommuter Policy

If you are located in FL, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Provide clinical leadership for utilization management, prior authorization, appeals and grievances, and provider quality activities across Florida Medicaid, LTC, and D-SNP populations
• Support timely, evidence-based coverage decisions aligned with clinical guidelines, plan policies, and regulatory expectations
• Partner with United Clinical Services and enterprise teams to support regulatory changes and strengthen clinical operations
• Participate in clinical rounds, conduct peer-to-peer reviews, and represent the health plan in Medicaid fair hearings as appropriate
• Contribute to performance goals related to HEDIS, STAR Ratings, CAHPS, and NPS
• Identify care gaps and help advance evidence-based interventions that improve clinical quality and member outcomes
• Participate in peer review activities, including Quality of Care and Quality of Service evaluations
• Provide clinical leadership during interdisciplinary rounds and support evidence-based standards of care
• Promote evidence-based practice and standardized clinical approaches that support high-quality care
• Engage network providers to address care gaps, support quality improvement, and encourage evidence-based practice
• Build solid relationships with provider organizations, health systems, and community partners to support quality, utilization, and member experience goals
• Apply knowledge of AHCA requirements and applicable state and federal Medicaid regulations to support compliant clinical operations
• Support implementation of policy and process changes that enhance clinical programs and operations
• Help reduce unwarranted variation in care through provider education, engagement, and best practices

Leadership Expectations

• Partner with the Chief Medical Officer and plan leadership to help advance clinical strategies aligned with market, regulatory, and organizational priorities
• Support development and execution of care models that improve outcomes and member experience
• Mentor and support clinical and operational colleagues to encourage growth, collaboration, and strong performance
• Help foster a culture of accountability, collaboration, and continuous improvement
• Bring clinical insight into care management, population health, and quality improvement initiatives
• Contribute to strategic planning, program development, and operational priorities

Core Competencies

• Strong clinical leadership and sound medical judgment
• Knowledge of Medicaid and Florida AHCA regulatory requirements
• Experience with utilization management and