Director, Highly Integrated Dual Eligible Special Needs (HIDE-SNP) Long-Term Services and Supports (LTSS)
Director, Highly Integrated Dual Eligible Special Needs (HIDE-SNP) Long-Term Services and Supports (LTSS)
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1 Vacancy
Job Description
Job Summary
- Develop and implement operational plans to improve LTSS access utilization and quality.
- Lead initiatives to align LTSS operations with contractual and regulatory requirements.
- Serve as the primary liaison for LTSS vendor relationships including quality oversight and performance monitoring.
- Manage oversight of delegated entities or First Tier Downstream and Related entities delivering LTSS functions ensuring compliance with CMS and MDHHS requirements.
- Review delegate and vendor performance including reports and corrective action plans and monitor key performance trends related to LTSS delivery.
- Monitor LTSS performance across financial clinical and operational KPIs ensuring integration of new regulatory requirements.
Clinical & Operational Integration:
- Collaborate with leaders across the enterprise (e.g. Medical Directors Quality Improvement Utilization Management Care Management Medicare Product Development Claims Digital Services Population Health Value Stream Leads) to ensure cohesive service delivery.
- Oversee utilization management for LTSS including critical incident reporting and resolution.
- Support integration of LTSS service coordination systems (e.g. care management platforms provider portals) with enterprise data systems.
- Lead implementation and oversight of LTSS elements of the CMS-approved Model of Care (MOC) including individualized care planning risk stratification interdisciplinary team (ICT) coordination and timely HRAs.
- Align LTSS operations with the plans Quality Improvement Program and Care Management framework to improve health outcomes.
Team Leadership & Development:
- Provide coaching and guidance to the LTSS team members.
Lead onboarding hiring and training of new team members to support program growth.
Foster a culture of accountability continuous improvement and member-centered care. - Data-Driven Decision Making:
Monitor and analyze LTSS data to identify trends and opportunities for improvement.
Promote equitable access to LTSS by identifying and addressing disparities related to race disability language geography and social determinants of health (SDOH).
Ensure services are accessible to individuals with disabilities limited English proficiency and those requiring culturally appropriate care.
Ensure budget adherence and forecast staffing needs based on service volume and complexity.
Regulatory & Contractual Compliance:
- Develop and maintain LTSS policies and procedures in accordance with federal and state guidelines.
- Oversee the grievance process and ensure timely resolution of member issues.
- Ensure execution of HIDE SNP contract requirements including MDHHS LTSS performance measures person-centered planning and timely reassessments.
- Lead readiness and response for state and CMS audits (e.g. MI Health Link SNP MOC).
- Ensure continuity of care during provider or service transitions per Medicare Medicaid and Michigan HIDE SNP contract.
Stakeholder Engagement:
- Engage with LTSS providers community partners and advocacy groups to enhance service coordination and satisfaction.
- Represent the organization in external audits and regulatory reviews.
- Required Bachelors Degree in related field
- Required Masters Degree or other advanced degree in nursing social work health services research health policy information technology or other relevant field.
- 7 years of relevant experience in related field Required
- 5 years of relevant experience in a leadership role with a demonstrated ability to lead teams and manage budgets. Required
Physical Demands
- Pallet to Waist (6 from floor) > 5 lbs: Seldom up to 10 lbs
- Waist to Waist > 5 lbs: Seldom up to 10 lbs
- Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
- Waist to Overhead > 5 lbs: Seldom up to 10 lbs
- Bilateral Carry > 5 lbs: Seldom up to 10 lbs
- Unilateral Carry > 5 lbs: Seldom up to 10 lbs
- Pushing Force > 5 lbs: Seldom up to 10 lbs
- Pulling Force > 5 lbs: Seldom up to 10 lbs
- Sitting: Frequently
- Standing: Occasionally
- Walking: Occasionally
- Forward Bend - Standing: Seldom
- Forward Bend - Sitting: Occasionally
- Trunk Rotation - Standing: Seldom
- Trunk Rotation - Sitting: Occasionally
- Reach - Above Shoulder: Seldom
- Reach - at Shoulder or Below: Seldom
- Handling: Occasionally
- Forceful Grip > 5 lbs: Seldom
- Forceful Pinch > 2 lbs: Seldom
- Finger/Hand Dexterity: Frequently
How Corewell Health cares for you
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Priority Health - 1231 E Beltline - Grand RapidsDepartment Name
PH - Utilization ManagementEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
40Days Worked
Monday - FridayWeekend Frequency
N/ACURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.
An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Required Experience:
Director
Employment Type
Full-Time
