Director, LTSS Clinical Care Management

Centene Corporation•Remote-IN, IN

38d•$127,300 - $236,100•Hybrid

About The Position

Centene is seeking a Director, LTSS Clinical Care Management to join their team. This role serves as the LTSS subject matter expert, leading RFP development and submissions while supporting the design, implementation, and growth of LTSS programs. The position's purpose is to direct the long-term care of members with physical/medical health needs and/or behavioral/mental health needs to develop and assess high quality, cost-effective healthcare outcomes. The Director will develop strategies and objectives within long-term care management to improve member and/or provider experience, provide leadership to the development, implementation, monitoring, and ongoing improvement of the long-term care management process, and set goals and objectives for the long-term care management team. This role will oversee care management data and reporting metrics to achieve quality and cost-effective healthcare results and work with senior leadership as required. The Director will lead long-term care management policies and procedures within the care management team to ensure compliance with corporate, state, and NCQA standards. They will oversee and monitor work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs. The role involves monitoring, reviewing, and signing off on contract-required reporting, as well as vendor oversight as required and applicable. The Director will attend conferences and stay up-to-date on the latest trends and best practices in Payer Care Management and related fields. They will lead and present process improvements for the long-term care management team to achieve cost-effective healthcare results and lead and coordinate large or special project work with other departmental functions. The Director will direct and evaluate departmental operations, including the long-term care management model, staffing, use of information technologies, onboarding, and staff competencies to achieve performance and quality objectives. They will review and monitor long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations, and participate with internal and external audits as required. The role contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care. The Director develops long-term care management strategies and influences decisions by providing recommendations that align to organizational objectives. They will provide coaching and guidance to the long-term care management team to improve member and provider experience and facilitate the delivery of high-quality care. The Director will develop the department budget while collaborating inter-departmentally and with senior leadership. They will develop the overall strategy for onboarding, hiring, and training new long-term care management team members to ensure adequate training and high-quality care to improve member and/or provider experience and ensure compliance. Other duties as assigned will also be performed.

Requirements

Graduate from an Accredited School of Nursing or a Bachelor's degree and 7+ years of related experience, including prior management experience.
Master's degree or Graduate from an Accredited School of Nursing and 7+ years of related experience, including prior management experience.
Equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position.
Current state’s Registered Nurse (RN) license required preferred or Licensed Clinical Behavioral Health Professional or RN based on state contract requirements e.g., LCSW, LMSW, LMFT, LMHC, and RN with BH experience required preferred.

Nice To Haves

4+ years management experience preferred.
Expert knowledge of industry regulations, policies, and standards preferred.
Highly advanced clinical knowledge and ability to assess member needs in context of relevant diagnoses, treatment plans and goals, and identify potential gaps in care or risks for readmission or complications preferred.
Strong knowledge of healthcare managed care principles preferred.
Experience working with providers and healthcare teams to develop appropriate long-term service plans/care plans preferred.
Strong knowledge of medication indications and side effects preferred.

Responsibilities

Serves as the LTSS subject matter expert, leading RFP development and submissions while supporting the design, implementation, and growth of LTSS programs.
Directs the long-term care of members with physical/medical health needs and/or behavioral/mental health needs to develop and assess high quality, cost-effective healthcare outcomes.
Develops strategies and objectives within long-term care management to improve member and/or provider experience.
Provides leadership to the development, implementation, monitoring, and ongoing improvement of the long-term care management process.
Sets goals and objectives for long-term care management team and oversees care management data and reporting metrics to achieve quality and cost-effective healthcare results and working with senior leadership, as required.
Leads long-term care management policies and procedures within the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards.
Oversees and monitors work assignments and caseloads of long-term care management staff based on state requirements, care management staff experience, and member needs.
Monitors, reviews, and signs off on contract required reporting as required.
Vendor oversight as required and applicable to the role.
Attends conferences and stays up to date on latest trends and best practices in Payer Care Management and related fields, as applicable.
Leads and presents process improvements for the long-term care management team to achieve cost-effective healthcare results.
Leads and coordinates large or special project work with other departmental functions.
Directs and evaluates departmental operations, including the long-term care management model, staffing, use of information technologies, onboarding, and staff competencies to achieve performance and quality objectives.
Reviews and monitors long-term care member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations, and participates with internal and external audits as required.
Contributes to the development and improvement of clinical care pathways that enhance cost effectiveness while providing quality care.
Develops long-term care management strategies and influences decisions by providing recommendations that align to organizational objectives.
Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care.
Develops department budget while collaborating inter-departmentally and with senior leadership.
Develops the overall strategy for onboarding, hiring, and training new long-term care management team members to ensure adequate training and high-quality care to improve member and/or provider experience and ensure compliance.
Performs other duties as assigned.
Complies with all policies and standards.