Senior Director, LTSS Clinical Care Management

Centene Corp.; Northern (KY); Hybrid; USD 146,000 - 270,000; Full time

Job summary

Centene Corp. seeks a senior LTSS leader to oversee long-term care management for members with complex physical/medical and behavioral health needs.

You will drive strategy, ensure compliance with NCQA and state requirements, and lead cross-functional teams to deliver high-quality, cost-effective care. The role requires 5+ years in LTSS and management, with eligibility to reside in Indiana or relocate, and a proven track record in RFPs, program design, and performance improvement across care

Qualifications

• Requires graduate from an accredited school of nursing or a bachelor’s degree with 10+ years of related experience
• Master's degree or RN with 10+ years of related experience preferred
• Experience with LTSS programs, RFP development, and state contract requirements preferred

Responsibilities

• Lead and directs the long-term care management of members with physical/medical and behavioral health needs
• Oversee development, implementation, monitoring, and ongoing improvement of LTSS processes
• Ensure compliance with corporate, state, and NCQA standards for care management
• Coordinate large or special projects with other departments and provide SME guidance to senior leadership

Skills

LTSS Leadership

Program Management

Regulatory Compliance

Vendor Oversight

Stakeholder Engagement

Education

Bachelor's degree in Nursing or related field

Master's degree in related field

Job description

**Position Purpose:** Leads and directs the long-term care management of members with physical/medical health and/or behavioral/mental health care needs to develop and assess high quality, cost- effective healthcare outcomes. Leads and develops strategies and objectives within care management to improve member and/or provider experience.**Key Details:** Must reside in Indiana or be willing to relocate to Indiana. A minimum of 5 years of LTSS experience is required. This role serves as the LTSS subject matter expert, leading RFP development and submissions while supporting the design, implementation, and growth of LTSS programs.* Provides oversight and leadership to the development, implementation, monitoring, and ongoing improvement of the long-term care management process* Develops and provides senior leadership team a vision and direction for the department to achieve functional goals, and effectively communicates these goals to the long-term care management team* 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* Leads and enforces 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* Attends conferences and stays up to date on latest trends and best practices in Payer Care Management and related fields, as applicable* Leads and coordinates large or special project work with other departmental functions* Provides subject matter expert guidance to senior leadership and long-term care management team, which may include the latest long-term care management policies, procedures, and standards* 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* Reviews internal reports to ensure adherence to department budget and identify trends to effectively forecast* Implements long-term care management strategies that align to organizational objectives* Engages with onboarding, hiring, and training new long-term care management team members to support future growth and strategy* Provides coaching and guidance to long-term care management team to improve member and provider experience and facilitate delivery of high-quality care* Leads and manages process improvements for the long-term care management team to achieve cost-effective healthcare results and presents to senior leadership team as applicable* Performs other duties as assigned* Complies with all policies and standards**Education/Experience:** Positions Primarily overseeing RN team members: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 10+ years of related experience, including prior management experience. Or, Positions Primarily overseeing BH team members: Requires a Master's degree or Graduate from an Accredited School of Nursing and 10+ years of related experience, including prior management experience. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. 5+ 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. **License/Certification:*** Positions overseeing RN team members: Current state's Registered Nurse (RN) license preferred or* Positions overseeing BH team members: 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 Pay Range: $146,000.00 - $269,600.00 per year