Director, MyCare HCBS Waiver(Preferred Experience with LTSS, Community Based Services, Medicaid, Waivers/Authorizations)

Job Summary:

Director, MyCare HCBS Waiver is responsible for developing, directing and overseeing CareSource MyCare HCBS Waiver and Long-Term Care Services and Supports (LTSS) case management programs.

Essential Functions:

• Assures the quality and consistency of MyCare HCBS Waiver care management activities delivered by CareSource staff, delegates, external partners, and contracted vendors
• Develops and provides input to align internal policies, procedures, and goals regarding MyCare HCBS Waiver programs
• Working with the AVP of Integrated Health, assumes responsibility for the overall function and operational, clinical, and professional growth of MyCare HCBS Waiver services program
• Establishes a team culture that drives excellence in member experience, operations, and quality
• Supports Health Services programs by contributing to policies, programs, accreditation, cost, and quality activities relative to MyCare HCBS Waiver program
• Assumes responsibility for the fiscal and regulatory management of MyCare HCBS Waiver Programs
• Assumes a lead role in ensuring high quality case management is delivered within product lines which include MyCare Waiver and LTSS services
• Member of the collaborative team and may provide input to the assessments, treatment plans and evaluation of high-risk members in HCBS Waiver settings
• Implementation and oversight of all clinical/care management functions for individuals receiving MyCare HCBS Waiver services, including but not limited to: Intake and assessments, care and service planning, care coordination, transition planning, consumer hearings and patient and caregiver education and training
• Implementation and oversight of all contracted provider management functions for providers of MyCare HCBS Waiver Services including but not limited to: quality oversight and monitoring and operation of incident management, investigation and response system
• Implementation and oversight of all program management functions, including but not limited to compliance with program requirements, rule and regulations
• Implementation and management of program policies and procedures and protocols that are aligned with federal and state requirements, for example: member complaints process and community education
• Develop, implement, monitor, and/or revise Care Management policies, procedures and goals as needed or required
• Ongoing review and revision of MyCare HCBS Waiver Care Management P&P to support compliance, reduce cost, and improve the quality of care
• Accountable for the creation and implementation of cost savings initiatives for MyCare Waiver
• Manage the care management services for CareSource MyCare HCBS Waiver
• Ensure compliance with all contracts, statutes and regulations.
• Ensure meeting or exceeding appropriate clinical requirements established by State
• Ensure that all Care Management programs align with and meet regulatory and accreditation standards
• Collaborate with the internal/delegate Care Management staff ongoing and share/implement best practice
• Develop, implement, monitor, and/or recommend revisions to government program bids for MyCare HCBS Waiver and LTSS services
• Develop and sustain community partner/service agency relationships
• Lead pertinent team projects ongoing
• Monitor MyCare HCBS Waiver Care Management budgets ongoing; describe variance detail monthly
• Participate and represent CareSource externally with speaking engagements, State and regional committee work
• Update MyCare HCBS Waiver program description documents annually
• Evaluate Care Management effectiveness ongoing and conduct outcome evaluation on all programs ongoing
• Coordinate member satisfaction survey activities
• Conduct a HCBS MyCare HCBS Waiver program evaluation annually
• Create (annually) and monitor (quarterly) the MyCare HCBS Waiver work plan
• Perform any other job duties as requested

Education and Experience:

• Bachelor's degree in nursing, social work, healthcare administration or related field or equivalent years of relevant work experience is required
• 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 is required
• Three to five (3-5) years of leadership/management experience is required
• Managed Care experience is preferred
• Clinical experience in healthcare delivery is preferred

Competencies, Knowledge and Skills:

• Intermediate proficiency level with Microsoft Office,including Outlook, Word and Excel
• Ability to operate smart phone, iPad, or other mobile communication devices to ensure productivity and ability to perform essential functions
• Facets experience is preferred
• Prior experience with and knowledge of CareAdvance is preferred
• 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

Licensure and Certification:

• Current, unrestricted license in the state of Ohio as a Registered Nurse (RN), Licensed Social Worker (LSW) or Licensed Independent Social Worker (LISW), Psychologist, or Licensed Professional Clinical Counselor (LPCC) is required
• Case Management certification is highly preferred
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.
• Employment in this position is conditional pending successful clearance of a driver's license record check.  If the driver's license record results are unacceptable, the offer will be withdrawn or, if you have started employment in this position, your employment in this position will be terminated

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Requires travel to external delegate office location and State meetings. May be required to perform occasional travel related duties as needed to ensure administration of the program
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members and may refer members to other CareSource resources

Compensation Range:

CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type (hourly/salary):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business