Director, Care Management – LTSS

This is a fully remote position, open to applicants in Illinois.

📋 Description

• Direct the long-term care of members to develop and evaluate high-quality, cost-effective healthcare outcomes.

• Formulate strategies and objectives within long-term care management to enhance member and provider experiences.

• Guide the performance, improvement, and professional growth of the long-term care management and care management teams.

• Establish policies and procedures to ensure adherence to corporate, state, and NCQA standards.

• Supervise and monitor staff work assignments and caseloads.

• Oversee, review, and authorize contract-required reporting.

• Provide oversight for vendor relationships.

• Participate in conferences and stay updated on payer care management trends and best practices.

• Lead and present initiatives for process improvements.

• Coordinate and direct large or special projects in collaboration with other departments.

• Manage and assess departmental operations, staffing, information technology usage, onboarding, and staff competencies.

• Analyze member data to identify trends and enhance performance and quality of care.

• Engage in internal and external audits.

• Contribute to the development and enhancement of clinical care pathways.

• Formulate care management strategies and influence decisions through informed recommendations.

• Mentor and guide the care management team.

• Create department budgets as necessary.

• Develop or assist in onboarding, hiring, and training strategies.

• Act as a consumer advocate for MLTSS enrollees within the IL Health Plan, focusing on policy development, planning, decision-making, and oversight.

• Execute additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Candidates must be residents of Illinois.

• A bachelor's degree along with 7+ years of relevant experience, including previous management experience.

• Equivalent experience gained through accomplishments in applicable knowledge, duties, scope, and skills reflective of this position may be accepted as a substitute.

• Extensive expertise in LTSS and Waiver programs.

• Proven experience in leading care management operations.

• Comfort in presenting information to leadership.

• Strong analytical skills in data analysis.

• Proven ability to drive performance outcomes.

• Managed care experience is highly preferred.

• Familiarity with corporate, state, and NCQA standards.

• Capability to oversee caseloads, reporting, vendors, audits, staffing, onboarding, and staff competencies.

• Ability to create and enhance clinical care pathways.

• Competence in developing strategies and recommendations that align with organizational objectives.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase options.

• Tuition reimbursement programs.

• Paid time off in addition to holidays.

• Flexible working arrangements including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in the total compensation package.

• An equal opportunity employer with a focus on diversity.