Long-Term Services and Supports/ Dual Eligible Special Needs Plan SME (Compact or PA Licesned)

About the role

Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities. We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.

Responsibilities

• Provide direction for health plan market/product level operational oversight, management and performance improvement
• Leverage industry expertise and expert knowledge, grounded in research and industry best practice, to provide high value consulting and advisory services
• Deliver innovative, integrated solutions in support of client goals and engagements
• Support or lead engagements ensuring completion of contracted services
• Create and/or manage to project plans
• Write proposals/reports
• Present to Client executives
• Facilitate, advise and persuade key decision makers and influencers
• Deliver concise, clear interpersonal communication to both internal and external audiences
• Facilitate streamlined exchange of information with all levels of Clearlink and client organization(s)
• Articulate performance across multiple projects with qualitative and quantitative results/outcomes
• Influence others to understand and accept strategies, goals and plans in response to changing business conditions
• Develop methodologies and best practices to be applied across individual account strategies/client plans
• Establish goals and track progress to ensure achievement
• Act in interim leadership capacity to provide supervision and oversight for teams and activities in a direct supervisory model
• Identify opportunities to improve workflow, generate accurate, high quality productivity, support organizational compliance with requirements and deliver reductions in associated costs with improvement in organizational quality performance in collaboration with Client leaders
• Develop or update policies and procedures as required to support business needs and requirements
• Identify opportunities to streamline and/or automate workflows for accurate, high quality production and improved results in cost savings, or outcomes measurement
• Coach and motivate staff to reach established engagement goals, deliverables and KPIs
• Audit and support Client preparation for external audits and surveys

Qualifications

• Demonstrated LTSS subject matter expertise in the areas of nursing facility services, HCBS, Personal Care services, respite, employment and community integration services, BH integration and SDOH and the impacts to care delivery models and each special population
• Familiarity with NCQA, URAC, CMS Star ratings and state quality requirements
• Experience managing complex work in challenging environments through the alignment of resources and prioritization of efforts to ensure on time, in scope project and/or strategic delivery
• Managed care industry expertise in trends, innovation, operations, financing, costs, requirements, performance and outcomes
• New product/market design and implementation in the Commercial, Medicare, Medicare Advantage, Medicaid or associated lines of business
• New population identification, program design and implementation to support needs/requirements of increasingly complex memberships while ensuring stable operations and target outcomes
• Define product requirements and operational capabilities in alignment with federal and state requirements incorporating new requirements as they arise from the state, waivers or new market entry
• Partner with CM to ensure clinical and operational oversight
• Partner with IT and business to maintain, optimize, and transform the technology
• Strong understanding of legal and regulatory frameworks, healthcare administration models, and internal audit procedures
• Work closely with concepts such as HIPAA, as well as State’s Department of Insurance, Federal and State Health and Human Services, CMS, NCQA, and URAC, to ensure compliance with complex regulatory structures
• Strategic thinker with ability to produce and manage system-wide change through influence and persuasion
• Knowledge of project management principles, methods, and techniques
• Ability to organize, prioritize, and manage multiple complex projects
• Excellent communication skills both written and oral
• High proficiency with core office software (Excel, Word, and PowerPoint). Visio skills preferred
• Current unencumbered Compact RN license
• Bachelor’s Degree in Healthcare Administration or related field, Master’s degree preferred
• 5+ years progressive leadership experience in health plan operations, delivering results and managing teams and projects in a health plan setting and/or consulting environment; driving complex, multi-faceted, multi-site, application/operational change/improvement programs and activities
• 3+ years of management experience in a government payor environment at a Director or equivalent level with experience in multiple lines of business (Medicare, Medicaid, Healthcare Exchange, etc)
• 5+ years of Medicaid or LTSS experience

Physical Requirements

• Must be able to sit in a chair for extended periods of time
• Must be able to engage in continuous social interaction, successfully manage stressful high conflict situations, and balance multiple duties, expectations and responsibilities simultaneously
• Must be able to fluently communicate both verbally and in writing using the English language
• Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types
• Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse
• Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices
• Must be able to speak so that you are able to accurately express ideas by means of the spoken word

Other Information

Expected Hours of Work: Monday - Friday 8a.m. – 5 p.m.; with ability to adjust to Client schedules as needed

Travel: May be required, as needed by Client

Direct Reports: None