Director, Long-Term Services & Supports (LTSS) (New York)

Job Description

Job Summary

This position is responsible for maintaining regulatory compliance, operational continuity, quality oversight, and the integrated care management functions required across DSNP, MLTC, and other complex integrated product lines.
The position has key responsibilities requiring oversight of the following Integrated Programs; DSNP, MLTC, MAP, FIDE, SNP and Delegates. The Director requires subject-matter expertise in Medicare-Medicaid integrated programs, including DSNP, MLTC, and associated LTSS benefit structures. The position ensures regulatory alignment, operational integrity, and quality performance across these programs.

Job Duties

• Experience in Management of Delegated Care Management Entities. 
• Provide direct oversight of the SWH Delegated Care management (DCM) External vendors partners and the HP assigned internal DCM Manager /Supervisor ensuring:
  • Adherence to contractual performance requirements
  • Accurate and timely reporting and Analytics
  • Compliance with UM/CM standards
  • Timely identification and correction of performance issues
    
• Delegated Care Management oversight is a core regulatory requirement, oversight and  monitoring, audit readiness, and operational performance.
• UM criteria and clinical decision-making alignment
• Care management workflows, including person centered planning and LTSS care coordination
• Quality programs, including Medicare and Medicaid quality standards
• Performance accountability for internal teams and delegated entities
• Ensure that UM and CM processes are fully integrated with quality goals, preventing compliance gaps and ensuring strong Health Care Services outcomes.
• Medicare Stars, HEDIS, and Quality Regulatory Requirements
• Medicare Stars measures
• HEDIS clinical quality metrics
• Interventions that improve plan performance for medically and socially complex vulnerable members
• Operational Stability and Staff Leadership
  
  

The Director of LTSS Services serves as the operational leader for cross functional teams supporting vulnerable LTSS populations. This includes:

• Managing interdisciplinary teams
• Leading process improvement initiatives
• Ensuring readiness for audits, surveys, and external reviews
• Maintaining continuity for members requiring high touch case management
  
• Hires, trains, develops and manages team; demonstrates accountability for team performance and achievement of department-specific goals. 
• Local travel may be required (based upon state/contractual requirements).

Job Qualifications

REQUIRED QUALIFICATIONS:

• At least 7 years of experience in health care, including at least 4 years experience in a health care delivery network supporting long-term services and supports (LTSS) and in-home supportive services (IHSS), or equivalent combination of relevant education and experience.
• At least 3 years of health care management/leadership experience.
• Registered Nurse (RN), Licensed Practical Nurse (LPN), Licensed Vocational Nurse (LVN), Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Health Education Specialist (CHES), Licensed Professional Counselor (LPC), Licensed Professional Clinical Counselor (LPCC), Licensed Marriage and Family Therapist (LMFT, Doctor of Psychology (PhD or PsyD). Clinical licensure and/or certification required ONLY if required by state contract, regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice.
• Knowledge and experience with disability and senior access issues.
• Demonstrated knowledge of community resources.
• Proactive and detail-oriented.
• Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
• Ability to work independently, with minimal supervision and demonstrate self-motivation.
• Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
• Ability to develop and maintain professional relationships with individuals.
• Strong time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
• Ability to work cross functionally within a highly matrixed organization.
• Excellent verbal and written communication skills.
• Microsoft Office suite and applicable software programs proficiency.

PREFERRED QUALIFICATIONS:

• Experience working with in-home supportive services (IHSS), public authorities, and community-based organizations (CBOs).

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Pay Range: $88,453 - $206,981 / ANNUAL
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

About Us

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.