Division Director of CCMC

Virginia Information Technologies Agency • Richmond, VA

1d • $164,705 - $184,411

About The Position

The Division Director of Cardinal Care Managed Care (CCMC) provides leadership, strategic direction, and operational oversight for Virginia Medicaid’s Cardinal Care Managed Care delivery system. The Director is accountable for ensuring that the Commonwealth’s managed care program operates effectively and efficiently, complies with federal and state requirements, and aligns with DMAS strategic priorities, contractual obligations, and the needs of Medicaid members and providers.

As the agency’s senior leader for managed care operations, the Director establishes a unified operating model across the functions consolidated within the CCMC Division. The role provides leadership across care management, complex care monitoring, contract management, policy and special populations, member and provider solutions, managed care operations, and managed care program administration. The Director establishes accountability, strengthens cross-functional coordination, improves operational performance, and ensures consistent oversight of the managed care delivery system.

The position has in-office requirements driven by business needs, including in-person training or meetings and engagement with internal and external stakeholders. The agency follows Commonwealth teleworking policies; work in the office may be required as business needs dictate, and telework arrangements may be modified or rescinded.

Requirements

• Extensive experience in Medicaid, managed care, healthcare administration, health insurance, public-sector health programs, or a related field.
• Extensive experience leading complex healthcare programs, such as health care benefits, Medicaid long-term care, pharmacy benefit management, operations, or organizational functions.
• Extensive experience managing large, multidisciplinary teams and/or complex organizational operations.
• Extensive experience working with managed care organizations, healthcare providers, or government healthcare programs.
• Extensive experience developing and implementing policies, programs, contracts, or operational strategies.
• Extensive experience working effectively with executive leadership, government agencies, vendors, providers, community organizations, and other stakeholders.
• Extensive experience with systems, programs, or computer software, including Microsoft Suites.
• Extensive knowledge or experience with Medicaid and CHIP federal and state laws, regulations, and policies, managed care, or public health systems.
• Extensive experience meeting deadlines and managing multiple priorities or initiatives.
• Extensive executive-level communication and stakeholder engagement skills, including advising senior leadership, communicating complex clinical and policy issues to diverse audiences, engaging provider and medical communities, and representing an organization in high-level forums.
• Ability to submit an application and/or résumé electronically through the state website; mailed, faxed, emailed, or hand-delivered applications and résumés are not accepted.
• Successful completion of a fingerprint-based criminal history background check, education checks if applicable, and work history verification with references.
• Submission of a Statement of Economic Interest (financial disclosure).

Nice To Haves

• Extensive knowledge of managed care principles, models, and financing; provider contracting; strategic planning; and overall service delivery.
• Knowledge and skills in developing and implementing strategic goals to lead staff and the division.
• Considerable knowledge of value-based purchasing, delivery system reform, and care coordination models.
• Extensive leadership experience analyzing and articulating complex policy concepts, envisioning change, and promoting creative and innovative approaches.

Responsibilities

• Provide leadership, strategic direction, and operational oversight for Virginia Medicaid’s Cardinal Care Managed Care delivery system.
• Ensure the managed care program operates effectively and efficiently and aligns with federal and state requirements, DMAS strategic priorities, contractual obligations, and the needs of Medicaid members and providers.
• Establish a unified operating model across managed care functions consolidated within the CCMC Division.
• Lead across care management, complex care monitoring, contract management, policy and special populations, member and provider solutions, managed care operations, and managed care program administration.
• Establish clear accountability, strengthen cross-functional coordination, improve operational performance, and ensure consistent oversight of the managed care delivery system.
• Conduct or participate in in-person training and meetings and engage with internal and external stakeholders as business needs require.
• Advise senior leadership, communicate complex clinical and policy issues to diverse audiences, engage provider and medical communities, and represent the organization in high-level internal and external forums.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: No Education Listed