Director, LTSS Clinical Care Management

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. Leads long-term care management policies and procedures to ensure compliance with corporate, state, and NCQA standards. Oversees work assignments and caseloads of long-term care management staff. Monitors, reviews, and signs off on contract required reporting. Provides vendor oversight. Attends conferences and stays up to date on trends. Leads process improvements and coordinates large projects. Directs departmental operations including staffing, technology, onboarding, and staff competencies. Reviews member data to identify trends and improve performance. Contributes to development of clinical care pathways. Develops department budget. Develops strategy for onboarding, hiring, and training new team members.