RN Director, LTSS Clinical Care Management
Core
Directs long-term care management for members with physical/medical and behavioral/mental health needs to develop cost-effective healthcare outcomes and improve member/provider experience.
Role type
Senior Director, Clinical Care Management
Builds
Long-term care management strategies, processes, and departmental operations
Domain
Healthcare / Managed Care / Long-Term Services and Supports (LTSS)
Required skills
Registered Nurse (RN) license, leadership of RN teams, value-based care management, Medicaid/Managed Care program experience, data analysis, health informatics, clinical reporting, change management, budget development, vendor oversight, compliance with NCQA/state regulations, care plan development, medication knowledge
Preferred skills
BSN degree, 4+ years direct RN managerial experience, Child Welfare/STAR Kids/CHIPS program experience, resource utilization group (RUG) certification, knowledge of industry regulations, advanced clinical assessment skills, provider collaboration
Technologies
Health informatics systems, clinical reporting tools
Responsibilities
Develop and implement long-term care management processes and policies; set goals and oversee data/reporting metrics; monitor staff caseloads and work assignments; lead process improvements and special projects; direct departmental operations including staffing and training; review member data to identify trends and improve performance; develop department budget; provide coaching to the care management team
Seniority
Director, strategic leadership with hands-on management