Director Health Plan Long Term Services & Supports (LTSS)

For this position we are seeking a (RN) Registered Nurse who lives in VIRGINIA and must be licensed for the state of VIRGINIA.

Director will support a team Managers who all manage a case load of field Nurse Case Managers supporting our LTSS Medicaid program We are looking for someone with strong leadership and experience with direct reports. Previous MCO experience is strongly preferred with LTSS experience.

This is a remote position that will allow you to anywhere within the state of VA.

Must be able to commute to Richmond VA office for leadership meetings when needed.

Home office with internet connectivity of high speed required.

Core Business hours are Monday – Friday 8 AM to 5 PM EST (Flexibility is needed to support team)

Job Summary

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Knowledge/Skills/Abilities

• Directs the health plans implementation, monitoring and integration of Long-Term Supports and Services (LTSS), including Adult Day Healthcare, Personal Care Assistance, Home and Community-based Waivers (HCBS), and Community Transition/Money Follows the Person.

• Operationalizes the Plans LTSS responsibilities and oversight delineated in the State-specific Memorandum of Understanding (MOU) or Contract Scope of Work

• Collaborates with County and community-based organization leadership

• Participates in County advisory groups and liaises with consumer advocacy organizations, members, caregivers (as appropriate) and other community-based organizations (CBOs) to ensure program integrity and identify areas for development.

• Monitors and reports on quality and outcome measures that align with the Molina clinical and social model of care and the State LTSS program goals as stated in MOU or Contract

• Develops policies and procedures that provide health plan guidance on integrated services and the incorporation of LTSS into individualized care plan development.

• Provides oversight of all clinical management functions for LTSS programs including but not limited to: adherence to State and Federal contracts; assessment; service planning; care coordination; transition planning, and participant and caregiver education and training.

• Identifies needs for process changes and training to better serve members and adhere to both Molina model of care goals, regulatory requirements, and enterprise standardization.

• Participates in the recruitment and hiring of LTSS staff with appropriate skills and experience.

• 25-35% local travel required.

Job Qualifications

Required Education

Bachelors Degree in Public Health, Public Policy, Health Administration, Gerontology, Social Work, or related field

and/or relevant experience in lieu of clinical experience required.

Required Experience

• Min. 5 years health care management experience, including State Medicaid LTC (both institutional and home and community based).

• Experience creating interpretive guidelines and program development.

• Proven ability to set and achieve aggressive program objectives and goals.

• Proven ability to implement an effective monitoring program to include providing constructive criticism and requiring acceptable corrective action plans.

• Management of professional and non-professional staff.

• 3-5 years health care information systems experience.

Required License, Certification, Association

Active and unrestricted applicable State-Licensed Nurse, Licensed Independent Social Worker (LISW), or has Masters Degree in Nursing, Healthcare, Social Work, Gerontology or other healthcare field.

Preferred Education

Masters Degree in Nursing, Healthcare, Social Work, Gerontology or other healthcare field preferred.

Preferred Experience

N/A

Preferred License, Certification, Association

N/A

To all current Molina employees: If you are interested in applying for this position, please apply through the intranet job listing.

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

Pay Range: $79,607.91 – $172,483.8 / ANNUAL

Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.