Director Provider Network Management Long Term Services & Support

Responsibilities

• Accountable for the development and execution of strategic planning for LTSS and HCBS network development and management.
• Lead the development and execution of the LTSS/HCBS network strategy to ensure sufficient provider capacity, participant access, geographic coverage, service availability, and compliance with CHC program requirements.
• Oversee network planning for core LTSS/HCBS service categories, including but not limited to personal assistance services, home health, adult day services, residential habilitation, service coordination-related provider interfaces, participant-directed services, durable medical equipment, home modifications, emergency response systems, transportation-related supports, and other community-based services.
• Oversee LTSS/HCBS provider contracting strategy, including contract development, rate negotiations, contract amendments, provider terminations, new provider onboarding, and value-based payments (VBP).
• Ensure provider contracts align with state Medicaid requirements, health plan policies, value-based care priorities, quality expectations, claims requirements, credentialing standards, and operational performance expectations.
• Lead or support negotiations with high-impact providers, including large home care agencies, adult day, residential providers, specialized LTSS providers, and regional provider organizations, among others.
• Ensure providers receive timely guidance regarding contractual requirements, claims processes, authorization protocols, Electronic Visit Verification (EVV) expectations, quality initiatives, and regulatory changes.
• Ensure the LTSS/HCBS provider network meets all applicable state, contractual, and internal network adequacy standards.
• Lead ongoing monitoring of access indicators, including provider availability, service initiation timeliness, geographic coverage, specialty service gaps, participant complaints, grievance trends, authorization delays, and service interruption risks.
• Build and maintain effective relationships with LTSS/HCBS providers, provider associations, community organizations, advocacy groups, and state partners.
• Lead provider engagement strategies that promote transparency, responsiveness, operational clarity, and shared accountability for participant outcomes.
• Oversee LTSS/HCBS provider forums, trainings, communications, issue-resolution processes, and escalation pathways.
• Foster team engagement and growth through consistent coaching, mentorship, and performance evaluations, supporting career development while addressing performance gaps in a timely and effective manner.
• Responsible for departmental staffing decisions and providing supervision to assigned staff, writes and performs annual reviews, and monitors performance issues as they arise.
• Establish clear goals, accountability structures, workflows, and performance expectations for direct reports and functional teams.
• Foster a culture of collaboration, regulatory discipline, provider partnership, operational excellence, and continuous improvement.

Qualifications

• Bachelor’s degree (or equivalent experience) in Business or health related disciplines such as Healthcare Administration or Healthcare management or equivalent business experience.
• 8 to 10 years of progressive business management.
• 5 to 10 years Managed Care industry experience including contracting and reimbursement experience.
• 5 or more years people management experience, managing teams and project management.
• 3 years Medicaid and long term services and support (LTSS) and home and community based service (HCBS) experience required; new program implementation experience preferred; knowledge base of Medicare crossover claims set up and oversight required.
• A valid driver’s license and current auto insurance required.

Benefits

• Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k)

Pay

• Competitive pay

Schedule

• Hybrid work schedule