Director, MLTSS Clinical Operations

Location
Norfolk, VA
Salary
Competitive
Posted
Sep 24, 2018
Closes
Dec 21, 2018
Ref
116334BR
Function
Nurse
Industry
Healthcare
Hours
Full Time
Overview:

Optima Health Community Care is hiring a dynamic Registered Nurse for the role of Director, MLTSS Clinical Operations in Norfolk, VA.


Department/Position Overview:
This key position requires:

    Bachelor's degree in Nursing and Masters Degree in Business Administration, Healthcare Administration or Nursing.Progressive management experience required with proven outcomes in all aspects of clinical operations and medical care delivery systemEffective technical skills regarding health plan administration and model of care operational concepts.Extensive knowledge of regulatory requirements and policy coverage guidance applicable to Medicaid/Medicare clinical operationsKnowledge and experience with regulations and best practices applicable to care management of vulnerable populations.Proven ability to ensure clinical operations performance through analysis, critical decision-making and implementation of automated solutions.MLTSS experience highly preferred.

Division Highlights:

Optima Health Community Care is a Commonwealth Coordinated Care Plus (CCC Plus) Medicaid plan for many older people and those with disabilities. CCC Plus is a Medicaid managed care program through the Virginia Department of Medical Assistance Services (DMAS).

With Optima Health Community Care, members benefit from an individualized, fully-integrated program with a state-wide network of providers. As an Optima Health Community employee, you will join a care team committed to providing customized and personalized support and services in the community that our members can count on. Optima Health is a service of Sentara Healthcare, so joining Optima is joining the Sentara Healthcare family.

Sentara Benefits:

Sentara employees strive to make our communities healthier places to live. We’re setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. For more information about our employee benefits, CLICK HERE!

Join our team, where we are committed to quality healthcare, improving health every day, and provide the opportunity for training, development, growth!

Other

Progressive management experience required with proven outcomes in all aspects of clinical operations in a medical care delivery system.

Must possess effective technical skills regarding health plan administration and model of care operational concepts.

Extensive knowledge of regulatory requirements and policy coverage guidance applicable to Medicaid/Medicare clinical operations.

Knowledge and experience with regulations and best practices applicable to care management of vulnerable populations.

Proven ability to ensure clinical operational performance though analysis, critical decision-making and implementation of automated solutions.

Keyword: MLTSS, Registered Nurse, RN, Medicaid, Managed care, operations, clinical

Equal Opportunity Employer



Responsibilities:

The Director, MLTSS Clinical Operations is the clinical operations and an LTSS subject matter expert, and is responsible for the operational components of care management and service coordination of the MLTSS membership. Will provide day to day clinical operational support for all program operations across all markets with a focus on continual evaluation and management of documentation of customer needs and all aspects of business processes to assure systematic processes are being utilized to capacity to optimize system efficiencies



Qualifications:

Education Level
RN- Bachelor's Level Degree AND
Masters degree in Business Administration, Health
Administration or Nursing required

Experience
A minimum of 5 years of experience in or with Medicaid, disability related programs and/or Long Term Service & Support required.

A minimum of 5 years of experience management within a medium to large sized public sector managed care organization.

License
Registered Nurse

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