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Senior Director, LTSS Clinical Care Management
Centene Corporation. Lead and direct long-term care management for members with physical/medical and/or behavioral/mental health care needs .
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in long-term care management, including the development and implementation of care strategies, compliance with industry regulations, and oversight of healthcare teams. Possesses advanced clinical knowledge to assess member needs and improve care outcomes.
Highest-signal resume keywords
Long-Term Care ManagementHealthcare Managed Care PrinciplesClinical Knowledge and AssessmentRegulatory ComplianceTeam Leadership and Development
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Care Management StrategiesData Analysis and ReportingBudget Adherence and ForecastingContract ManagementProcess Improvement
Soft Skills
CommunicationCoaching and MentoringProject CoordinationProblem Solving
Certifications & Qualifications
Registered Nurse (RN) LicenseLicensed Clinical Behavioral Health Professional
Industry Keywords
LTSS ExperienceNCQA StandardsBehavioral HealthHealthcare ComplianceMember Experience
About the role
Key responsibilities & impact- Lead and direct long-term care management for members with physical/medical and/or behavioral/mental health care needs
- Develop and assess high-quality, cost-effective healthcare outcomes
- Lead and develop care management strategies and objectives to improve member and provider experience
- Oversee development, implementation, monitoring, and ongoing improvement of the long-term care management process
- Provide senior leadership with vision and direction for the department and communicate goals to the care management team
- Oversee work assignments and caseloads based on state requirements, staff experience, and member needs
- Monitor, review, and sign off on contract-required reporting
- Provide vendor oversight as applicable
- Lead and enforce long-term care management policies and procedures for compliance with corporate, state, and NCQA standards
- Attend conferences and stay current on trends and best practices in payer care management
- Lead and coordinate large or special projects with other departments
- Provide subject matter expertise to senior leadership and the care management team
- Review and monitor long-term care member data to identify trends and improve operating performance and quality of care
- Participate in internal and external audits
- Review internal reports for budget adherence and forecasting trends
- Implement strategies aligned with organizational objectives
- Support onboarding, hiring, and training of new team members
- Coach and guide the care management team to improve member and provider experience and deliver high-quality care
- Lead process improvements and present results to senior leadership
- Perform other duties as assigned
- Comply with all policies and standards
Requirements
What you’ll need- Must reside in Indiana or be willing to relocate to Indiana
- Minimum of 5 years of LTSS experience required
- Graduate from an Accredited School of Nursing or a Bachelor's degree and 10+ years of related experience, including prior management experience (positions primarily overseeing RN team members)
- Master's degree or graduate from an Accredited School of Nursing and 10+ years of related experience, including prior management experience (positions primarily overseeing BH team members)
- Equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position may qualify
- 5+ years management experience preferred
- Expert knowledge of industry regulations, policies, and standards preferred
- Highly advanced clinical knowledge and ability to assess member needs in context of relevant diagnoses, treatment plans and goals, and identify potential gaps in care or risks for readmission or complications preferred
- Strong knowledge of healthcare managed care principles preferred
- Experience working with providers and healthcare teams to develop appropriate long-term service plans/care plans preferred
- Strong knowledge of medication indications and side effects preferred
- Current state's Registered Nurse (RN) license preferred for positions overseeing RN team members
- Licensed Clinical Behavioral Health Professional or RN based on state contract requirements (e.g., LCSW, LMSW, LMFT, LMHC, and RN with BH experience) required/preferred for positions overseeing BH team members
Benefits
Comp & perks- Competitive pay
- Health insurance
- 401K plan
- Stock purchase plans
- Tuition reimbursement
- Paid time off plus holidays
- Flexible approach to work with remote, hybrid, field or office work schedules
- Additional forms of incentives may be included in total compensation
- Equal opportunity employer committed to diversity