RN Director, LTSS Clinical Care Management

This is a fully remote position, open to applicants in Louisiana, +3 more states.

📋 Description

• Oversee the long-term care of members with physical, medical, and/or behavioral or mental health requirements.

• Create and evaluate effective, high-quality healthcare outcomes that are cost-efficient.

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

• Manage a team of RN managers.

• Lead the development, implementation, monitoring, and continuous enhancement of the long-term care management process.

• Establish team objectives and goals while supervising care management data and reporting metrics.

• Direct long-term care management policies and procedures to ensure adherence to corporate, state, and NCQA standards.

• Supervise work assignments and caseloads according to state requirements, staff expertise, and member needs.

• Oversee and approve contract-required reporting.

• Provide oversight for vendors.

• Participate in conferences and stay informed on trends and best practices in Payer Care Management.

• Lead and present improvements in processes.

• Coordinate significant or special projects with other departments.

• Direct and assess departmental operations, staffing, information technology, 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 of clinical care pathways.

• Formulate strategies and recommendations that align with organizational objectives.

• Mentor and guide the care management team.

• Collaborate with senior leadership and other departments to create the departmental budget.

• Develop strategies for onboarding, hiring, and training.

• Perform additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Graduation from an accredited School of Nursing.

• 7+ years of relevant clinical nursing experience, encompassing current or prior management experience, or equivalent knowledge and skills.

• A current state Registered Nurse (RN) license or Compact Nursing License is required.

• RUG certification must be obtained within 90 days of hire for Superior Health Plan; RUG certification is necessary if supervising RN team members.

• Minimum of 4+ years of leadership experience managing RNs within a managed care organization or a state government agency.

• Experience in Value-Based Care Management, particularly in Child Welfare, Medicaid/Managed Care, CHIP/CHIPS, STAR Kids, or STAR Health programs.

• Texas DFPS background check is required.

• A Bachelor of Science in Nursing (BSN) is preferred.

• 4+ years of direct RN managerial experience is preferred.

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

• Highly advanced clinical expertise and the ability to assess member needs concerning relevant diagnoses, treatment plans, and goals, with the ability to identify possible 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 create suitable long-term service plans/care plans is preferred.

• Comprehensive knowledge of medication indications and side effects is preferred.

• Experience in data analysis, health informatics, clinical reporting, and change management is a plus.

🏝️ Benefits

• Health insurance.

• 401K.

• Stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

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

• Mileage reimbursement for travel.

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