Sr Director LTSS

Job ID: J125708
Company: Gateway Health Plan
Location: Wilmington, DE, United States
Full/Part Time: Full time
Job Type: Regular
Posted at: Jun 18, 2018

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Description

JOB SUMMARY

This job provides senior leadership and oversight to the LTSS function. The incumbent is detial oriented, drives the delivery of quality and cost-effective care, member/provider satisfaction and quality outcomes. The incumbent, along with the DE Plan Chief Medical Officer, DE Plan VP, Care Management, is accountable for strategic planning, strategy execution and implementation of LTSS care management programs.  Models and provides leadership for delivery of high quality, patient-focused care and ensure the successful implementation of effective strategies and approaches. The incumbent holds themselves accountable to learning, growing and improving, and they appreciate this behavior in their team members. They learn how to size up a team quickly, identifying those who are avid contributors and those who need mentoring or should be in alternate roles making the team successful.

ESSENTIAL RESPONSIBILITIES

  • Perform management responsibilities including, but not limited to: involved in hiring and termination decisions, coaching and development, rewards and recognition, performance management and staff productivity.  Plan, organize, staff, direct and control the day-to-day operations of the department; develop and implement policies and programs as necessary; may have budgetary responsibility and authority.
  • Collaborate with DE Plan leadership team to develop, implement and monitor care management strategies to support unique targets for care costs, member engagement and market competitiveness.
  • Ensure staff compliance with internal and external regulatory requirements and profession practice standards.  
  • Develop, gain approval for and implements strategic plan, budget, staffing and annual operating plan for DE business
  • Drive operations/programs to comply with accreditation and regulatory standards, including but not limited to NCQA, DHSS Medicaid and Medical Assistance operations, URAC, CMS and Gateway Health corporate and medical polices.
  • Other duties as assigned.( Responsible for financial success, balanced budget and filled positions to meet the needs of the department and adhering to the SLAs of the STATE Contract.  Responsible for attestation of all required reports timely (QCMMR).  Responsible for leading, testing, training of staff on all new system roll-outs.)

EDUCATION

Required

  • Bachelor's Degree in Health Administration

Substitutions

  • None

Preferred

  • Master's Degree in Nursing

EXPERIENCE

Required

  • 7 - 10 years in Managed Care Support
  • 3 - 5 years in Management

Preferred

  • None

LICENSES AND CERTIFICATIONS

Required (one of the following)

  • Registered Nurse (RN)
  • Licensed Social Worker (LSW) - Non-Specific

Preferred

  • Certified Case Manager (CCM)

SKILLS

  • Insurance
  • Government Programs
  • Communication Skills
  • Analytical Skills

Language (Other than English)

None 

Travel Required

0%  - 25%


PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS

Position Type

Office-Based

Teaches / trains others regularly

Frequently

Travel regularly from the office to various work sites or from site-to-site

Occasionally

Works primarily out-of-the office selling products/services (sales employees)

Never

Physical work site required 

Yes

Lifting: up to 10 pounds

Does Not Apply

Lifting: 10 to 25 pounds

Does Not Apply

Lifting: 25 to 50 pounds

Does Not Apply

Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.

Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.

Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibit discrimination against all individuals based on their race, color, religion, sex, national origin, sexual orientation/gender identity or any other category protected by applicable federal, state or local law. Highmark Health and its affiliates take affirmative action to employ and advance in employment individuals without regard to race, color, religion, sex, national origin, sexual orientation/gender identity, protected veteran status or disability.
EEO is The Law
Equal Opportunity Employer Minorities/Women/ProtectedVeterans/Disabled/Sexual Orientation/Gender Identity (http://www1.eeoc.gov/employers/upload/eeoc_self_print_poster.pdf)
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact number below.
For accommodation requests, please call HR Services at 844-242-HR4U or visit HR Services Online at HRServices@highmarkhealth.org

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