Director, LTSS Clinical Care Management

Role Overview

• Serves as the LTSS subject matter expert, leading RFP development and submissions while supporting the design, implementation, and growth of LTSS programs
• Directs the long-term care of members with physical/medical health needs and/or behavioral/mental health needs to develop and assess high quality, cost-effective healthcare outcomes
• Develops strategies and objectives within long-term care management to improve member and/or provider experience
• Provides leadership to the development, implementation, monitoring, and ongoing improvement of the long-term care management process
• Sets goals and objectives for long-term care management team and oversees care management data and reporting metrics to achieve quality and cost-effective healthcare results and working with senior leadership
• Leads long-term care management policies and procedures within the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards
• Oversees and monitors work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs
• Monitors, reviews, and signs off on contract required reporting as required

Requirements

• Graduate from an Accredited School of Nursing or a Bachelor's degree and 7+ years of related experience, including prior management experience
• Current state’s Registered Nurse (RN) license required preferred or Licensed Clinical Behavioral Health Professional or RN based on state contract requirements
• 4+ years management experience preferred
• Expert knowledge of industry regulations, policies, and standards preferred
• Highly advanced clinical knowledge and ability to assess member needs in context of relevant diagnoses, treatment plans and goals, and identify potential gaps in care or risks for readmission or complications preferred
• Strong knowledge of healthcare managed care principles preferred
• Experience working with providers and healthcare teams to develop appropriate long-term service plans/care plans preferred
• Strong knowledge of medication indications and side effects preferred

Benefits

• competitive pay
• health insurance
• 401K and stock purchase plans
• tuition reimbursement
• paid time off plus holidays
• flexible approach to work with remote, hybrid, field or office work schedules