Division Director of CCMC

DHRM•Richmond, VA

1d•Hybrid

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 ensures the 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. As the agency’s senior leader for managed care operations, the Director establishes a unified operating model across the managed care 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 coordination across functions, improves operational performance, and ensures consistent oversight of the managed care delivery system. The position is based in the Richmond, Virginia area and has in-office requirements driven by business needs, including in-person training or meetings and engagement with internal and external stakeholders. Telework arrangements may be available but are a privilege and may be modified or rescinded based on performance or business needs.

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 the ability to advise senior leadership, communicate complex clinical and policy issues to diverse audiences, engage provider and medical communities, and represent an organization in high-level internal and external forums.
Ability to complete fingerprint-based criminal history, applicable education, and work history checks with references.
Ability to submit 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 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 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 and strengthen cross-functional coordination.
Improve operational performance and ensure consistent oversight of the managed care delivery system.
Advise senior leadership, communicate complex clinical and policy issues to diverse audiences, engage provider and medical communities, and represent the agency in high-level internal and external forums.
Develop and implement policies, programs, contracts, or operational strategies.
Lead staff and the division in developing and implementing strategic goals.
Manage deadlines and multiple priorities or initiatives.