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STAR+PLUS Sr. Director, Health Services
3 months ago
ABOUT THE ROLE: The Senior Director of Health Services will oversee the implementation and ongoing execution of the strategic and operational business plans for Community Health Choice. This position will be responsible for Service Coordination, Case Management, and UM review for PA and long-term services and supports. The Senior Director will build relationships across all business lines to ensure cohesiveness, and all contractual obligations are met. Oversight of staffing models/resource and budget management, policies and procedures, and reporting. The Senior Director will collaborate across multiple business lines to ensure Community Health Choice objectives are aligned, business strategies are developed and delivered timely, and financial, compliance and quality objectives are met.
Hire, develop, and motivate a high performing team to meet organizational goals and objectives while effectively managing change. Ensure that processes are aligned with NCQA, HHSC and all governing bodies. Oversee and ensure compliance with all applicable Federal and State regulations relevant to the plan's function. Develop and maintain internal departmental auditing tools and processes for proactive monitoring for all relevant quality and compliance performance metrics. Partner effectively with the STAR/CHIP Program operations to meet all LTSS requirements.
RESPONSIBILITIES: Oversee the implementation and ongoing execution of strategic and operational business plans
- Responsible for Service Coordination, Case Management, and UM review for PA and long-term services and supports
- Build relationships across all business lines to ensure cohesiveness and meet contractual obligations
- Manage staffing models/resource and budget management, policies and procedures, and reporting
- Collaborate across multiple business lines to ensure objectives are aligned and met
- Hire, develop, and motivate a high performing team
- Ensure processes are aligned with NCQA, HHSC, and governing bodies
- Oversee compliance with Federal and State regulations
- Develop and maintain internal auditing tools and processes
- Partner effectively with STAR/CHIP Program operations
QUALIFICATIONS: Education/Specialized Training/Licensure:
- Licensed RN in the state of TX or compact license required, BSN
- Work Experience (Years and Area):
- 3-5 years of experience working in Medicaid Long Term Services & Supports (LTSS), and/or experience with care management.
- Experience with Waiver and HBCS programs.
- Experience with data-driven program management.
- Experience working with a government program.
- Management Experience (Years and Area):
- 5-7 years of experience in a Senior Manager, or Director role managing large teams of 75+ employees
