Director, LTSS Clinical Care Management

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

📋 Description

• Acts as the subject matter expert for LTSS, spearheading the development and submission of RFPs while facilitating the design, implementation, and expansion of LTSS programs.

• Oversees the long-term care of members with physical and/or behavioral health needs, aiming to create and evaluate high-quality, cost-effective healthcare outcomes.

• Formulates strategies and objectives within long-term care management to enhance the experience of members and/or providers.

• Provides leadership in the creation, execution, monitoring, and continuous enhancement of the long-term care management process.

• Establishes goals and objectives for the long-term care management team while supervising care management data and reporting metrics to ensure quality and cost-effective healthcare results in collaboration with senior leadership.

• Directs policies and procedures related to long-term care management within the care management team to guarantee adherence to corporate, state, and National Committee for Quality Assurance (NCQA) standards.

• Supervises and evaluates work assignments and caseloads of long-term care management staff, taking into account state requirements, staff experience, and member needs.

• Reviews, monitors, and approves contract-required reporting as necessary.

⛳️ Requirements

• Must be a graduate from an Accredited School of Nursing or hold a Bachelor's degree with 7+ years of related experience, including previous management experience.

• A current state Registered Nurse (RN) license is required, or a Licensed Clinical Behavioral Health Professional or RN depending on state contract specifications.

• Preferred 4+ years of management experience.

• In-depth knowledge of industry regulations, policies, and standards is preferred.

• Highly advanced clinical knowledge and the ability to assess member needs in relation to relevant diagnoses, treatment plans, and objectives, as well as identify potential care gaps or risks for readmission or complications is preferred.

• Strong understanding of healthcare managed care principles is preferred.

• Experience collaborating with providers and healthcare teams to formulate suitable long-term service plans/care plans is preferred.

• Strong understanding of medication indications and side effects is preferred.

🏝️ Benefits

• Competitive pay

• Health insurance

• 401K and stock purchase plans

• Tuition reimbursement

• Paid time off plus holidays

• Flexible work arrangements including remote, hybrid, field, or office schedules