Director, Long Term Care Supports and Services
Richmond VA 23233
Job DescriptionThis position is responsible for all provisions of Long Term Services and Support (LTSS) home and community-based services. Additional responsibilities include ensuring local LTSS processes, policies and procedures meet regulatory, NCQA, and CMS standards and coordinate with clinical processes; collaborating with internal and external entities to improve accessibility standards and quality practice standards to reduce medical costs across the service delivery systems; and overseeing long-term care provider reviews, utilization reviews, participant and stakeholder satisfaction surveys, and member health and welfare.
- Responsible for the oversight of the long-term community-based and facility programs to administer services and activities in the most integrated setting appropriate to the needs of qualified individuals with LTSS needs, including the children, elderly, and members with disabilities
- Oversees utilization management, intake, case management, disease management, and service coordination for members eligible for long-term services and supports
- Responsible for overseeing the MLTSS request for proposals and implementations of new business.
- Ensures MLTSS programs meet ADA, Olmstead, NCQA, and other applicable Health Plan, State, and CMS regulations.
- Designs and implements the training programs for staff involved in MLTSS.
- Ensures programs meet ADA, Olmstead and other applicable state and CMS standards
- Participates in stakeholder forums for children, elderly, and individuals with disabilities, care givers, advocates and LTSS providers.
- Collaborates with the community relations to review member satisfaction surveys and incorporate findings into programs and operations.
- Works closely with the clinical leadership and other members of the Executive team to create and implement LTSS policy for Magellan Complete Care of Virginia.
- Provides input into the yearly budget process providing cost-effective and quality care coordination and case management services.
- Collaborates with the Medical Director to provide oversight of clinical programs, intake, care coordination/case management strategies, and operations for integrated LTSS, physical and behavioral healthcare.
- Provides oversight and consultation for the Magellan Complete Care Quality Management and Improvement (QM/QI) Program and Utilization Management (UM) Program including: monitoring effectiveness and compliance with goals, prevention programs, network development and provider reviews, quality of care concerns and adverse incidents, medical practice of network or sub-capitated providers, clinical service delivery system, coordination with the after-hours team and appeals-panel physicians, and oversight of clinical appeals.
- Develops strategy to be the market leader in the self-directed LTSS industry.
- Ensures connection of tasks, responsibilities, direction and functional goals to Magellan Complete Care of Virginia`s strategic direction.
- Develops and maintains strategic partnerships with internal and external stakeholders.
- Provides direction and oversight to the LTSS staff.
- Manages projects and initiatives effectively to ensure proper support of those involved and/or affected.
- Partners and collaborates with the Department, Magellan Staff, and other stakeholders to provide effective and efficient support and deliverables.
- Utilizes data results to improve processes and manage system efficiencies.
- Participates in and facilitate meetings with LTSS staff, external partners and stakeholders as required and requested.
General Job Information
TitleDirector Long Term Care Supports and Services
Job FamilyClinical Services Group
CountryUnited States of America
FLSA StatusUnited States of America (Exempt)
Recruiting Start Date2/21/2019
Date Requisition Created2/21/2019
EducationBachelors (Required), Masters
License and Certifications - RequiredRN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt
License and Certifications - Preferred
Other Job Requirements
- Experience in Medicaid Managed Care or Medicare Advantage.
- Knowledge of Medicaid Personal Care.
- 5+ years direct care and/or long term care program experience serving individuals with disabilities or the frail elderly population.
- 7+ years progressive supervisory and human services management experience.
- Minimum 1 year home care nursing or experience in community-based nursing with programs promoting self-direction/self determination.
- Proficient in MS Office Product Suite.
- Able and willing to quickly learn various business systems/software.
- Strong written and verbal communications skills.
Magellan Health Services is proud to be an Equal Opportunity Employer and a Tobacco-free workplace. EOE/M/F/Vet/Disabled
“I receive a high level of support from our Senior Management Team to execute on our vision. They are always accessible and approachable, something I’ve found to be very unique to Magellan.”