Dir, MLTSS Operations

About the role

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth. This role is responsible for the strategic leadership, performance oversight, and operational execution of the Managed Long-Term Services and Supports (MLTSS) program. It ensures the delivery of high-quality, compliant, and member-centered services across home- and community-based care, as well as facility-based settings (e.g., nursing homes and assisted living facilities). The role partners cross-functionally with internal stakeholders and external providers to drive program effectiveness, maintain regulatory compliance, and optimize member outcomes, while leading a high-performing operations team that supports care management delivery. Operates within Government Programs, supporting the MLTSS population across multiple care settings, overseeing both clinical-adjacent operations and non-clinical support functions, and responsible for program performance, regulatory compliance, and operational excellence.

Responsibilities

• Strategic Leadership & Program Oversight: Develop and execute the strategic direction for MLTSS Operations aligned with Government Programs and enterprise priorities; ensure delivery of high-quality, cost-effective, and member-centric services across the MLTSS continuum; drive continuous improvement initiatives to enhance service delivery, operational efficiency, and member satisfaction.
• Regulatory Compliance & Program Integrity: Ensure full compliance with NJ MLTSS contract requirements, state and federal regulations, and accreditation standards; oversee program audits, readiness activities, and corrective action plans; develop and maintain policies and procedures aligned with regulatory requirements.
• Operations & Care Coordination Excellence: Oversee care coordination activities across multiple care settings to ensure seamless member experiences; ensure timely and accurate completion of member assessments in accordance with regulatory guidelines; lead the non-clinical operations team supporting authorization management and provider outreach.
• Provider & Stakeholder Collaboration: Partner with Provider Contracting and Network teams to maintain an adequate and high-performing LTCSS network; collaborate with internal stakeholders (Medical Economics, Clinical, Compliance, Analytics) and external partners to drive program outcomes; represent MLTSS Operations in enterprise and regulatory workgroups.
• Data, Performance & Continuous Improvement: Leverage data insights to monitor program performance, identify trends, and drive evidence-based decision-making; collaborate with analytics teams to develop reporting on population health outcomes and operational performance; identify operational risks and implement mitigation and process improvement strategies.
• People Leadership & Talent Development: Lead, develop