Director, MyCare HCBS Waiver; LTSS, Community Based Services, Medicaid

Job Summary

Job Summary: Director, MyCare HCBS Waiver is responsible for developing, directing and overseeing Care Source MyCare HCBS Waiver and Long-Term Care Services and Supports (LTSS) case management programs.

• Assures the quality and consistency of MyCare HCBS Waiver care management activities delivered by Care Source staff, delegates, external partners, and contracted vendors
• Develops and provides input to align internal policies, procedures, and goals regarding MyCare HCBS Waiver programs
• Working with the AVP of Integrated Health, assumes responsibility for the overall function and operational, clinical, and professional growth of MyCare HCBS Waiver services program
• Establishes a team culture that drives excellence in member experience, operations, and quality
• Supports Health Services programs by contributing to policies, programs, accreditation, cost, and quality activities relative to MyCare HCBS Waiver program
• Assumes responsibility for the fiscal and regulatory management of MyCare HCBS Waiver Programs
• Assumes a lead role in ensuring high quality case management is delivered within product lines which include MyCare Waiver and LTSS services
• Member of the collaborative team and may provide input to the assessments, treatment plans and evaluation of high-risk members in HCBS Waiver settings
• Implementation and oversight of all clinical/care management functions for individuals receiving MyCare HCBS Waiver services, including but not limited to:
  Intake and assessments, care and service planning, care coordination, transition planning, consumer hearings and patient and caregiver education and training
• Implementation and oversight of all contracted provider management functions for providers of MyCare HCBS Waiver Services including but not limited to: quality oversight and monitoring and operation of incident management, investigation and response system
• Implementation and oversight of all program management functions, including but not limited to compliance with program requirements, rule and regulations
• Implementation and management of program policies and procedures and protocols that are aligned with federal and state requirements, for example: member complaints process and community education
• Develop, implement, monitor, and/or revise Care Management policies, procedures and goals as needed or required
• Ongoing review and revision of MyCare HCBS Waiver Care Management P&P to support compliance, reduce cost, and improve the quality of care
• Accountable for the creation and implementation of cost savings initiatives for MyCare Waiver
• Manage the care management services for Care Source MyCare HCBS Waiver
• Ensure compliance with all contracts, statutes and regulations.
• Ensure meeting or exceeding appropriate clinical requirements established by State
• Ensure that all Care Management programs align with and meet regulatory and accreditation standards
• Collaborate with the internal/delegate Care Management staff ongoing and share/implement best practice
• Develop, implement, monitor, and/or recommend revisions to government program bids for MyCare HCBS Waiver and LTSS services
• Develop and sustain community partner/service agency relationships
• Lead pertinent team projects ongoing
• Monitor MyCare HCBS Waiver Care Management budgets ongoing; describe variance detail monthly
• Participate and represent Care Source externally with speaking engagements, State and regional committee work
• Update MyCare HCBS Waiver program description documents annually
• Evaluate Care Management effectiveness ongoing and conduct outcome evaluation on all programs ongoing
• Coordinate member satisfaction survey activities
• Conduct a HCBS MyCare HCBS Waiver program evaluation annually
• Create (annually) and monitor (quarterly) the MyCare HCBS Waiver work plan
• Perform any other job duties as requested

• Bachelor s degree in nursing, social work, healthcare administration or related field or equivalent years of relevant work experience is required
• Master s degree is preferred
• Minimum of seven (7) years of experience with government programs including at least 5 years of experience in HCBS waiver programs is required
• Three…