Director, Care Coordination Center(Managed Care Experience Required)

Job Summary:

The Director, Care Coordination Center assists the dual eligible President with all open projects and progress towards completion, program enhancements, development, and execution activities related to implementation and ongoing design and standardization for the Dual eligible and LTSS model.

Essential Functions:

• Collaborate with market and senior leadership to formulate and implement business strategies and operational plans to ensure core functionality, scalability, and ongoing department management to support LTSS (HCBS and NH) model
• This role will be in charge of overseeing the Care Coordination Center to ensure contractual compliance
• Primary responsibility for translating business and program vision and strategy into operational tactics - collaborating to build the necessary organizational support and infrastructure
• Establish post implementation strategy and goals to mitigate program risks
• Evaluates operational process effectiveness for accomplishing market goals and objectives; manage operation process improvement activities in collaboration with market teams
• Develop, translate, and execute key strategies for functional/ operational requirements
• Provide leadership and support for product expansion
• Incorporates industry standard, best practice project management tools and techniques in market initiatives 
• Recognizes and proactively manages operational dependencies and risks across market operations initiatives portfolio through effective change and risk management controls
• Works closely with leadership to establish, communicate, and perpetuate the corporate vision, ensuring appropriate communication to stakeholders
• Monitors performance across markets LTSSS/HCBS programs to leverage best practice and knowledge sharing for the purpose of improving outcomes through the standardization of evidence-based practices
• Assists the dual eligible President with the monitoring of legislative/governmental activities with the goal of advocating for the full integration LTSS/HCBS standard model, identifying opportunities and issues
• Interacts heavily within Dual Eligible, LTSS program business partners, and builds strong working relationships with all markets
• Engages stakeholders to ensure alignment
• Leads activities ensuring the delivery of high quality, consistent initiatives that result in optimum outcomes for members, providers, and program goals
• Recruits, develops, and leads key staff
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s Degree or equivalent years of relevant work experience is required
• A minimum of five (5) years of clinical operations/healthcare administration experience is required
• A minimum of five (5) years of experience driving performance and process improvements, is required in the health care insurance industry
• Experience with Government-regulated (Federal and/or State) health insurance products including Medicaid, Managed Care Waiver, FFS and Medicare is preferred 
• Experience implementing programs with focus on integration is required
• Project management experience preferred

Competencies, Knowledge, …