Executive Director, Medicaid Long-Term Services and Supports Network

CVS Pharmacy
Annapolis, MD
May 25, 2022
May 27, 2022
Full Time
Job Description The National Executive Director for Medicaid Long-Term Services and Supports (MLTSS) will provide network strategic plans, programs and market coordination for our growing Medicaid Network Operations across our Medicaid markets. The Executive Director's responsibility and complexity will vary by creating strategic plans for each targeted MLTSS service delivery areas. This position will lead: * A national network team that will provide high touch provider engagement program to LTSS providers (ie, nursing facilities and Intellectual and Developmental Disability and Behavioral Health providers (IDD). * Develop and coordinate market engagement with LTSS county and local market home & community based organizations. * Create, monitor and enhance our contracting templates for LTSS providers via our preferred, acceptable, discouraged, unacceptable contracting guidelines. * Lead LTSS strategic and operational development for our Network strategies over fee for service payment reimbursement, value based agreements, compliance functions and or cost management efforts. * Develop annual and revolving 3-year network plan for LTSS network strategy across all current and targeted expansion markets. * This leader will report to the Vice President Medicaid Networks and collaborate across the enterprise to ensure that objectives are aligned, business strategies are delivered and financial, compliance and quality objectives are met. Required Qualifications - 10 Years proven work experience in Medicaid Managed Care Long Term Care / Long Term Services and Supports (LTSS) program management. - The Executive Director will serve as a LTSS subject matter expert and advisor to internal partners across various functions and have exceptional communication skills. - Prior experience in managing Skilled Nursing Facilities (SNF) and/or IDD Providers, including claims payment processing, contracting and credentialing. - Capability to create and develop presentations for value proposition; ability to lead and direct the potential for network performance results and/or improvement. - 10+ years' experience in a Network Medicaid leadership capacity including managing people - Demonstrated successful management of large scale programs management including the following: - Drive National LTSS strategic growth and enhancement programs for SNF and IDD payment models and operational capabilities - Partner with the Medicaid segment Executive leadership in the development of short-term and long- term strategic plans required for Aetna's ongoing growth and success in the LTSS Medicaid segment. - Required to communicate w/internal and external parties by phone/in-person; may require travel to offsite locations. - Deliver operational performance and compliance: - Meet all applicable operational goals for quality of care, cost of care and operating expense and ongoing efficiency improvements. - Deliver value to providers by optimizing the provider experience and maximizing provider growth and retention. - Ensure that processes are aligned with the highest quality standards required by - Accreditation and Credentialing Organizations (for example, NCQA, etc.) - Oversee and ensure compliance with all applicable Federal and State regulations relevant to the plans function. - Develop and maintain tools and processes for proactive monitoring or all relevant quality and compliance performance metrics. - Partner effectively with Medicaid operational and clinical services operations to meet all LTSS requirements. Manage operations staff and develop workforce and organization: - Lead recruitment and operating model development to meet operational growth needs. - Develop and implement staffing models that are consistent, cost effective meeting all compliance obligations. - Collaborate with health plan operations and state Medicaid agency's building a transparent and trusting relationship, meeting all state objectives. - Lead, develop, motivate, and manage a high performing team to meet organizational goals and objectives while effectively managing change. - Lead effectively in a matrixed environment with critical business functions provided by shared service divisions (Engagement Hubs, Network) - Foster an environment that supports professional development, mobility, and operational excellence. COVID Requirements COVID-19 Vaccination Requirement CVS Health requires certain colleagues to be fully vaccinated against COVID-19 (including any booster shots if required), where allowable under the law, unless they are approved for a reasonable accommodation based on disability, medical condition, religious belief, or other legally recognized reasons that prevents them from being vaccinated. You are required to have received at least one COVID-19 shot prior to your first day of employment and to provide proof of your vaccination status or apply for a reasonable accommodation within the first 10 days of your employment. Please note that in some states and roles, you may be required to provide proof of full vaccination or an approved reasonable accommodation before you can begin to actively work. Preferred Qualifications - 8 - 10 years related Medicaid Network experience - Related experience in health operations, network relations and development, command of financials and claim pricing strategies, and sales interface. - Required experience building and maintaining relationships with Long-Term Services and Supports (MLTSS) Providers. - A successful track record managing and negotiating major provider contracts In depth knowledge of various reimbursement structures and payment methodologies for LTSS providers. - Knowledge and experience with value based contracting and accountable care models. - In-depth knowledge of managed care business, regulatory/legal requirements. - Solid leadership skills, including staff development and talent management. Education Master Degree Preferred / Bachelor's degree required Business Overview Bring your heart to CVS Health Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at its center - our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors (TM) support this purpose. We want everyone who works at CVS Health to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. We strive to promote and sustain a culture of diversity, inclusion and belonging every day. CVS Health is an affirmative action employer, and is an equal opportunity employer, as are the physician-owned businesses for which CVS Health provides management services. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

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