Dir, MLTSS Operations

Horizon Healthcare Services•Hopewell, NJ

1d•Remote

About The Position

This role is responsible for the strategic leadership, performance oversight, and operational execution of the Managed Long-Term Services and Supports (MLTSS) program. It ensures the delivery of high-quality, compliant, and member-centered services across home- and community-based care, as well as facility-based settings (e.g., nursing homes and assisted living facilities). The role partners cross-functionally with internal stakeholders and external providers to drive program effectiveness, maintain regulatory compliance, and optimize member outcomes, while leading a high-performing operations team that supports care management delivery.

Requirements

High School Diploma/GED required.
7–10+ years of progressive leadership experience in managed care, long-term services and supports, or healthcare operations.
Demonstrated experience leading complex, regulated programs (Medicaid/MLTSS strongly preferred).
Experience managing cross-functional teams and driving enterprise initiatives.
Deep understanding of MLTSS programs, home and community-based services, and long-term care delivery models
Strong knowledge of regulatory and compliance requirements
Strategic thinking and execution capabilities
Data-driven decision-making and performance management
Executive-level communication and stakeholder management
Change leadership and continuous improvement mindset
Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware.

Nice To Haves

Bachelor’s degree in Healthcare Administration, Nursing, Public Health, or related field preferred.

Responsibilities

Develop and execute the strategic direction for MLTSS Operations aligned with Government Programs and enterprise priorities.
Ensure delivery of high-quality, cost-effective, and member-centric services across the MLTSS continuum.
Drive continuous improvement initiatives to enhance service delivery, operational efficiency, and member satisfaction.
Ensure full compliance with NJ MLTSS contract requirements, state and federal regulations, and accreditation standards.
Oversee program audits, readiness activities, and corrective action plans.
Develop and maintain policies and procedures aligned with regulatory requirements.
Oversee care coordination activities across multiple care settings to ensure seamless member experiences.
Ensure timely and accurate completion of member assessments in accordance with regulatory guidelines.
Lead the non-clinical operations team supporting authorization management and provider outreach.
Partner with Provider Contracting and Network teams to maintain an adequate and high-performing LTCSS network.
Collaborate with internal stakeholders (Medical Economics, Clinical, Compliance, Analytics) and external partners to drive program outcomes.
Represent MLTSS Operations in enterprise and regulatory workgroups.
Leverage data insights to monitor program performance, identify trends, and drive evidence-based decision-making.
Collaborate with analytics teams to develop reporting on population health outcomes and operational performance.
Identify operational risks and implement mitigation and process improvement strategies.
Lead, develop, and retain a high-performing team, fostering a culture of accountability, collaboration, and continuous learning.
Oversee staff training, development, and performance management processes.
Assess workforce capabilities and implement targeted learning and development initiatives.