About the role

Director responsible for overseeing CareSource MyCare HCBS Waiver and LTSS case management programs. Ensures quality management and compliance while supporting operational and clinical growth.

Responsibilities

Develop, direct and oversee CareSource MyCare HCBS Waiver and Long-Term Care Services and Supports (LTSS) case management programs
Assure quality and consistency of MyCare HCBS Waiver care management activities delivered by CareSource staff, delegates, external partners, and contracted vendors
Develop and provide input to align internal policies, procedures, and goals regarding MyCare HCBS Waiver programs
Collaborate with the AVP of Integrated Health, assuming responsibility for overall function, operational, clinical, and professional growth of MyCare HCBS Waiver services program
Establish a team culture that drives excellence in member experience, operations, and quality
Support Health Services programs by contributing to policies, programs, accreditation, cost, and quality activities relative to MyCare HCBS Waiver program
Lead the fiscal and regulatory management of MyCare HCBS Waiver Programs
Ensure high quality case management is delivered within product lines including MyCare Waiver and LTSS services
Implement and oversee all clinical/care management functions for individuals receiving MyCare HCBS Waiver services
Manage care management services for CareSource MyCare HCBS Waiver
Ensure compliance with all contracts, statutes and regulations
Collaborate with internal/delegate Care Management staff ongoing and share/implement best practices
Create and monitor MyCare HCBS Waiver work plan

Bachelor’s degree in nursing, social work, healthcare administration or related field, or equivalent years of relevant work experience
Master’s degree is preferred
Minimum of seven (7) years of experience with government programs, including at least 5 years of experience in HCBS waiver programs
Three to five (3-5) years of leadership/management experience
Managed Care experience is preferred
Clinical experience in healthcare delivery is preferred
Intermediate proficiency level with Microsoft Office
Ability to operate smart phone, iPad, or other mobile communication devices
Familiarity with provider operations
Knowledge of clinical guidelines (Milliman, InterQual)
Knowledge of regulatory requirements for both Medicaid and Medicare
Strong financial background
Strong interpersonal skills and a high level of professionalism
Knowledge of managed care industry, trends, and accreditation
Knowledge of quality improvement and HEDIS programs/outcomes measurement
Excellent verbal and written communication skills
Strategic management skills
Excellent leadership, management and supervisory skills and experience
Ability to work independently and within a team environment
Effective problem-solving skills with attention to detail
Effective listening and critical thinking skills
Training/teaching skills
Negotiation skills/experience
Customer service oriented
Ability to develop, prioritize and accomplish goals.