Director, LTSS Clinical Care Management

Position Purpose

Serves as the LTSS subject matter expert, leading RFP development and submissions while supporting the design, implementation, and growth of LTSS programs.

Responsibilities

• 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
• Leads long-term care management policies and procedures within the care management team to ensure compliance with corporate, state, and 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
• Makes vendor oversight as required and applicable to the role
• Attends conferences and stays up to date on latest trends and best practices in Payer Care Management and related fields
• Leads and presents process improvements for the long-term care management team to achieve cost-effective healthcare results
• Leads and coordinates large or special project work with other departmental functions
• Directs and evaluates departmental operations, including the long-term care management model, staffing, use of information technologies, onboarding, and staff competencies to achieve performance and quality objectives
• Reviews and monitors long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations
• Contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care
• Develops long-term care management strategies and influences decisions by providing recommendations that align to organizational objectives
• Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care
• Develops department budget while collaborating inter-departmentally and with senior leadership
• Develops the overall strategy for onboarding, hiring, and training new long-term care management team members to ensure adequate training and high-quality care to improve member and/or provider experience and ensure compliance

Requirements

Candidate must reside in Indiana or be willing to relocate to Indiana.

Qualifications

• Positions overseeing RN team members: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 7+ years of related experience, including prior management experience.
• Positions overseeing BH team members: Requires a Master's degree or Graduate from an Accredited School of Nursing and 7+ years of related experience, including prior management experience.
• 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.

Skills

• Expertise in industry regulations, policies, and standards
• Advanced clinical knowledge and ability to assess member needs
• Knowledge of healthcare managed care principles
• Experience working with providers and healthcare teams
• Knowledge of medication indications and side effects

Benefits

Comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Pay

TBD

Schedule

TBD