$\newcommand{\g}{\nabla f}\newcommand{\tg}{\widetilde{\nabla f}}\newcommand{\R}{\mathbb R}
\newcommand{\vpi}{\varphi}\newcommand{\Om}{\Omega}$The answer is yes.
For $\Om=\R^n$, this follows from the identity
\begin{equation*}
\int_{\R^n}\frac{f(x+tu)-f(x)}t\,\vpi(x)\,dx=\int_{\R^n}\frac{\vpi(x-tu)-\vpi(x)}t\,f(x)\,dx, \tag{1}\label{1}
\end{equation*}
where $t\in\R\setminus \{0\}$, $u$ is a unit vector in $\R^n$, and $\vpi$ is any smooth function with support contained in some ball $B_\vpi$ of a strictly positive radius centered at the origin.
(The assumption that $\Om=\R^n$ can be made without loss of generality. Indeed, if $\Om\ne\R^n$, just extend the (say) $L$-Lipschitz function $f$ on $\Om$ to the $L$-Lipschitz function $\bar f$ on $\R^n$, quite naturally, by the infimal convolution formula $\bar f(x):=\inf_{y\in\Om}(f(y)+L\|x-y\|)$ for $x\in\R^n$.)
With $u\in\R^n$ fixed, for almost all $x\in\R^n$ we have
\begin{equation*}
\frac{f(x+tu)-f(x)}t=\g(x)\cdot u+r_1(x,t),
\end{equation*}
where $\cdot$ is the dot product, $|r_1(x,t)|\le2L$, $L$ is the Lipschitz constant of $f$, and $r_1(x,t)\to0$ as $t\to0$. So, by dominated convergence,
\begin{equation*}
\begin{aligned}
\int_{\R^n}\frac{f(x+tu)-f(x)}t\,\vpi(x)\,dx
&=\int_{B_\vpi}\frac{f(x+tu)-f(x)}t\,\vpi(x)\,dx \\
&\to \int_{B_\vpi}\g(x)\cdot u\,\vpi(x)\,dx \\
&=\int_{\R^n}\g(x)\cdot u\,\vpi(x)\,dx \\
&=(\g)(\vpi)\cdot u.
\end{aligned}
\tag{2}\label{2}
\end{equation*}
On the other hand, for all $x\in\R^n$
\begin{equation*}
\frac{\vpi(x-tu)-\vpi(x)}t=-\nabla\vpi(x)\cdot u+r_2(x,t),
\end{equation*}
where $r_2(x,t)\to0$ uniformly in $x\in2B_\vpi$ as $t\to0$. So, for $t$ close enough to $0$,
\begin{equation*}
\begin{aligned}
\int_{\R^n}\frac{\vpi(x-tu)-\vpi(x)}t\,f(x)\,dx
&=\int_{2B_\vpi}\frac{\vpi(x-tu)-\vpi(x)}t\,f(x)\,dx \\
& \to-\int_{2B_\vpi}\nabla\vpi(x)\cdot u\,f(x)\,dx \\
& =-\int_{\R^n}\nabla\vpi(x)\cdot u\,f(x)\,dx \\
& =(\tg)(\vpi)\cdot u.
\end{aligned}
\tag{3}\label{3}
\end{equation*}
Thus, by \eqref{1}--\eqref{3}, $\tg=\g$ as distributions, as claimed.
Similarly, $\tg=\g$ even as tempered distributions.