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Humana Healthy Horizons in Virginia is seeking a Director, Care Management of Long-Term Services and Supports (LTSS) who will lead teams of nurses and behavior health professionals responsible for care management. The Director, Care Management (LTSS) requires an in-depth understanding of how organization capabilities interrelate across the function or segment.

The Director, Care Management (LTSS) will provide oversight to ensure the company's Long‐Term Services and Supports (LTSS) Care Management and Contractual performance objectives are met for the Virginia Cardinal Care Medicaid program. They will ensure the program and resources are used effectively and successfully to execute short and long‐term population health goals.

• Leads, develops, and operationalizes LTSS Care Management/Coordination within Humana's Population Health strategy, education, and Quality Improvement activities for the clinical team.
• Develops, implements, measures, analyzes, and reports on LTSS programs and initiatives designed to improve the health and quality of life of our members.
• Ensures best practice standards and the NCQA Care Management criteria are used to assist with developing the documentation tools to create impactful member outcomes.
• Responsible for the planning, directing, and successful management of the LTSS Clinical Strategy for Department of Medical Assistance Services (DMAS) in Virginia.
• Provides input into function’s strategy.
• Leads, mentors, exemplifies, and inspires teams responsible for LTSS Care Management.
• Contributes to the success of associate and member experience in assigned region as well as across the Commonwealth/enterprise.
• Oversees the assessment and evaluation of members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitating interaction with resources appropriate for the care and well‐being of members.
• Makes decisions typically related to the implementation of new/updated programs or large‐ scale projects for the function and supporting technical/operational procedures and processes, and implements strategic plans, drives goals and objectives, and improves performance.
• Develops and maintains functioning teams to accomplish goals set by the division.
• Encourages professional responsibility and assists with professional development.
• Defines key personnel productivity and quality indicators that meet industry standards.
• When necessary, develops and updates process improvement plans for internal and external customers.
• Develops education and training programs for LTSS Care Management team, inclusive of case review and case study.
• Collaborates with other Humana leadership to identify the clinical tools and systems to support LTSS Care Management activities.
• Participates in Care Management Collaborative meetings as required by DMAS.
• Ensures that the Health Services team operates in compliance with Commonwealth and federal regulations, Commonwealth Contract Requirements, Humana Policies and NCQA Standards.

Use your skills to make an impact
 

Required Qualifications

• Must reside in the Commonwealth of Virginia.
• Bachelor’s degree.
• An active unrestricted Registered Nurse (RN) license in Virginia.
• Combination of eight (8) or more years of care management and care coordination experience.
• Two (2) or more years of experience working in the LTSS industry.
• Five (5) years of leadership experience leading large teams with proven success in directing and leading these teams.
• Prior work experience working with elderly, disabled, private duty nursing and/or nursing facility populations.
• Proven success in team building and training/coaching staff to meet operational requirements and goals.
• Proficiency in analyzing and interpreting clinical and utilization trends.
• Thorough understanding of health plan and regulatory rules, managed care, care management, disease management and referral processes.
• Ability to analyze and integrate information and make sound decisions based upon established guidelines.
• Commitment to the creation of a collaborative and supportive work environment.

Preferred Qualifications

• Master's degree in business administration, Nursing or a related field preferred.
• Care Management certification (CCM).

Additional Information

• Workstyle: This is a Remote position that will require you to travel.
• Travel: Up to 25% of the time to Humana Healthy Horizons office in Glen Allen, VA for collaboration and face to face meetings as well as interfacing with regulatory agencies.
• Direct Reports: Up to 5.