Clinical Care Management Director
About the Role
Serves as the LTSS (Long-Term Services and Supports) subject matter expert, leading RFP development, program design, and growth of long-term care services. Provides leadership in developing, implementing, and improving long-term care management processes to achieve high-quality, cost-effective healthcare outcomes. Sets strategic goals, oversees care management operations, monitors performance metrics, and ensures compliance with standards such as NCQA and state regulations. Leads process improvements, manages departmental operations, and evaluates data to enhance care quality and efficiency. Develops strategies, influences organizational decisions, and oversees staffing, onboarding, and training to ensure high standards of care. Coordinates large projects, manages vendor relationships, and contributes to clinical pathway development. Prepares departmental budgets and collaborates with senior leadership on strategic initiatives. Provides coaching to care teams and ensures adherence to policies, standards, and regulatory requirements.
Qualifications & Skills
- Graduate from an accredited nursing school or bachelor’s degree with 7+ years of related experience, including management.
- For behavioral health roles, Master’s degree or equivalent clinical licensure (e.g., LCSW, LMSW, LMFT, LMHC) with 7+ years of experience.
- 4+ years of management experience preferred.
- Expert knowledge of industry regulations, clinical assessment, managed care principles, and provider collaboration.
- Licenses/certifications: RN license or relevant behavioral health licensure based on role and state requirements.
- Strong leadership, strategic planning, data analysis, and communication skills.