LTSS Director - Clinical Health Services - Illinois

Job Description The Long Term Services & Supports (LTSS) Director-Clinical Health Services (Director), will partner closely with the LTSS Executive Director, Market CEO, and State Medicaid agency to build a transparent and trusting relationship while meeting state objectives. The Director will collaborate across the enterprise to ensure that the State LTSS program and Aetna objectives are aligned, business strategies are delivered and financial, compliance and quality objectives are met. Lead, develop, and motivate a high performing team (approximately 300 colleagues) to meet organizational goals and objectives while effectively managing change. Ensure that processes are aligned with the highest quality standards required by Accreditation and Credentialing Organizations (for example, NCQA). Oversee and ensure compliance with all applicable Federal and State regulations relevant to the plan's function. Develop and maintain tools and processes for proactive monitoring for all relevant quality and compliance performance metrics. Partner effectively with Medicaid Program Integrity operations to meet all LTSS requirements. This position shall ensure that LTSS staff are knowledgeable and adhere to the requirements of the Illinois HCBS Waivers, IPoC and service plans, Contract standards, the Money Follows the Person Program, Illinois Long-Term Care rules and regulations, and the Williams and Colbert consent decrees (as per section 9.1.40). Promote a clear vision aligned with company values and direction; sets specific challenging and achievable objectives and action plans; motivates others to balance customer needs and business success; challenges self and others to look to the future to create quality products, services, and solutions. Implements and monitors the business plan and oversees any implementations or business transitions impacting service operations. Develop and manage clinical operations focused on improving clinical and financial outcomes, member engagement, and satisfaction. Develop and implement staffing models that are consistent, cost effective, and compliant with contractual obligations. Lead recruitment and operating model development to meet operational growth needs. Foster an environment that supports professional development, mobility, and operational excellence. Develop, implement, and promote Health Services strategies, tactics, policies, and programs that drive the delivery of quality healthcare to establish competitive business advantage for Aetna Health Services strategies, policies, and programs. Oversee the implementation and on-going execution of the strategic and operational business plan for the business segment's clinical operations, inbound/outbound call queue, implementation, and/or plan sponsor operations. Coordinate business segment policies and procedures in support of financial, operational, and service requirements. Develop, implement, and evaluate policies and procedures, which meet business needs (may cross multiple business functions). Direct enhancements to business processes, policies, and infrastructure to improve operational efficiency (may cross multiple business functions). Collaborate and partner with other business areas across/within regions or segments and within other centralized corporate areas to ensure all workflow processes and interdependencies are identified and addressed on an on-going basis. Develop and participate in presentations and consultations to existing and prospective customers. Participate in internal and external health industry development efforts. This role will require the following functions: - Ability to develop business cases for new staffing investments and work with finance to secure funding when additional staff are warranted. - Ability to develop, evaluate and articulate current status, planning, and strategic initiatives via executive level presentations and able to speak professionally to Executive Level audience. - Ability to successfully motivate, drive and lead colleagues in Manager, Supervisory and field level positions. - Ability to interpret State contract to ensure IL market is performing to contract expectations. Pay Range The typical pay range for this role is: Minimum: 107,250 Maximum: 231,000 Please keep in mind that this range represents the pay range for all positions in the job grade within which this position falls. The actual salary offer will take into account a wide range of factors, including location. Required Qualifications - Licensed RN in the state of IL - 5-7 years of experience in a Senior Manager, or Director role managing large teams of 100+ employees - 3-5 years of experience working in Medicaid Long Term Services & Supports (LTSS), and/or experience with care management - Experience working within a matrixed organizational structure - Experience with data-driven program management - Ability to travel throughout the state of IL approximately 1-2 days/month as needed for meetings with team, providers, and state representatives Preferred Qualifications - IL resident preferred but we can consider out of state candidates if willing to travel into IL approximately one week each month. - Experience working in a government program - Advanced Microsoft Office skills - Previous experience with HFS/HSAG Education Bachelor's degree required with RN licensure; Master's degree preferred 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 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. We proudly support and encourage people with military experience (active, veterans, reservists and National Guard) as well as military spouses to apply for CVS Health job opportunities.