Senior Director, LTSS Clinical Care Management

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

📋 Description

• Lead and oversee long-term care management for members with physical, medical, and/or behavioral or mental health care requirements.

• Develop and evaluate high-quality, cost-efficient healthcare outcomes.

• Design and implement care management strategies and objectives to enhance the experience of both members and providers.

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

• Provide senior leadership with vision and direction for the department while effectively communicating goals to the care management team.

• Manage work assignments and caseloads according to state regulations, staff expertise, and member requirements.

• Monitor, review, and authorize contract-mandated reporting.

• Offer vendor oversight as needed.

• Enforce long-term care management policies and procedures to ensure compliance with corporate, state, and NCQA standards.

• Attend conferences and keep abreast of trends and best practices in payer care management.

• Lead and coordinate large or special projects in collaboration with other departments.

• Provide subject matter expertise to senior leadership and the care management team.

• Analyze long-term care member data to identify trends and enhance operational performance and quality of care.

• Participate in both internal and external audits.

• Review internal reports to ensure budget compliance and forecast trends.

• Implement strategies that align with organizational objectives.

• Assist in onboarding, hiring, and training new team members.

• Mentor and guide the care management team to improve member and provider experiences while delivering high-quality care.

• Drive process improvements and present outcomes to senior leadership.

• Perform additional duties as assigned.

• Adhere to all policies and standards.

⛳️ Requirements

• Must be a resident of Indiana or willing to relocate to Indiana.

• A minimum of 5 years of experience in Long-Term Services and Supports (LTSS) is required.

• Graduation from an Accredited School of Nursing or possession of a Bachelor's degree along with 10+ years of related experience, which includes previous management experience (positions primarily overseeing RN team members).

• A Master's degree or graduation from an Accredited School of Nursing and 10+ years of related experience, which includes prior management experience (positions primarily overseeing Behavioral Health team members).

• Equivalent experience gained through the achievement of applicable knowledge, duties, scope, and skills reflective of this position's level may qualify.

• Preferred 5+ years of management experience.

• Expert knowledge of industry regulations, policies, and standards is preferred.

• Highly advanced clinical knowledge and the ability to assess member needs in the context of relevant diagnoses, treatment plans, and goals, while identifying potential gaps in care or risks for readmission or complications is preferred.

• Strong knowledge 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.

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

• A current state's Registered Nurse (RN) license is preferred for positions overseeing RN team members.

• A Licensed Clinical Behavioral Health Professional or RN in accordance with state contract requirements (e.g., LCSW, LMSW, LMFT, LMHC, and RN with Behavioral Health experience) is required/preferred for positions managing BH team members.

🏝️ Benefits

• Competitive salary.

• Health insurance coverage.

• 401K retirement plan.

• Stock purchase plans.

• Tuition reimbursement program.

• Paid time off in addition to holidays.

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

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

• Equal opportunity employer dedicated to diversity.