Director, MyCare HCBS Waiver – Preferred Experience with LTSS, Community Based Services, Medicaid, Waivers/Authorizations
CareSource
full-time
Posted on:
Location Type: Hybrid
Location: Ohio • United States
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Salary
💰 $113,000 - $197,700 per year
Job Level
About the role
- 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
Requirements
- 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.
Benefits
- Comprehensive total rewards package
- Influenza vaccination requirement
- Reasonable accommodations for disabilities or medical conditions
- Flexible hours, including occasional evenings and/or weekends
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
case managementHCBS waiver programsgovernment programsclinical guidelinesregulatory requirementsfinancial managementquality improvementHEDIS programshealthcare deliverymanaged care
Soft Skills
leadershipmanagementinterpersonal skillscommunication skillsproblem-solvingcritical thinkingstrategic managementteamworkcustomer servicetraining skills
Certifications
Bachelor’s degreeMaster’s degree