Virginia Premier Health Plan, Inc.

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Director, LTSS & Dual Programs

Director, LTSS & Dual Programs

Job Locations 
US-VA-Glen Allen
Job ID 
2017-4085

Job Description

Overview

The Director of LTSS & Dual Programs has responsibility for creating and implementing the strategy and vision for network development of the CompleteCare product.

 

He/she has oversight for the management of Virginia Premier  long term care networks to ensure adequacy, quality and access.  Provides direction to a team of Managers of LTSS/Network Development to negotiate/renegotiate agreements and build relationships with skilled nursing facilities, adult day care centers, home health agencies, community service boards and related network providers (including CSBs, AAA’s, Care transition) .  Develops innovative programs and partnerships with long term service and support providers.  Partners with Medical Management to successfully implement initiatives.

 

 

Responsibilities

  • Provides leadership to a team of LTSS Managers, Network Development Manager and related personnel.
  • Creates strategic partnerships
  • Develops payment methodology for all specialties related to the dual demonstration program.
  • Leads on LTSS project/partnership implementation
  • Monitoring of LTSS quality metrics, develops programs to support providers in improving outcomes.
  • Involves oversight of identification, recruitment and the contracting of network providers including: Primary Care Physicians, Physician Specialists, Ancillary Vendors, and related providers.
  • Develops a sufficient network of skilled nursing facilities, home health agencies, personal care providers, adult day care centers and related providers.
  • Works very closely with CompleteCare AVP to develop and manage strong relationships with providers of long term care services and supports.
  • Collaborates with VPHP medical management staff to assist long-term service and supports providers streamline and standardize current processes (i.e. payment, authorization, coordination of care) and develop value based purchasing strategy for LTSS providers.
  • Provides prompt and efficient response to provider or provider-related issues with appropriate, objective documentation of concerns, recommendations for resolution, monitoring and re-evaluation.
  • Oversees the development of new reimbursement and pay-for-performance models.
  • Assure compliance with operational policies and production standards that result in provider network adequacy and member retention.
  • Contribute to preparation, update and production of all marketing and educational materials/manuals.
  • Lead training and motivation of staff to carry out their assigned job functions.
  • Demonstrate comprehensive understanding of Department of Medical Assistance Services (DMAS) and Centers for Medicare and Medicaid Services (CMS) contractual requirements.

Qualifications

MINIMUM EDUCATION REQUIREMENTS

  • Bachelor’s Degree in Health Services, Business Administration or related business fields.
  • Master’s Degree in Healthcare Administration, Public Health or related field preferred

SPECIAL KNOWLEDGE AND/OR SKILLS

  • Expertise in long term care services and supports
  • Knowledge of Home and Community Based Waiver services specifically Elderly and Disabled with Consumer Direction (EDCD) waiver
  • Demonstrated knowledge of reimbursement methodologies, managed care processes and Medicaid managed care business.
  • Ability to manage multiple projects while meeting deadlines and achieving business goals.

PHYSICAL REQUIREMENTS

  • Physical health sufficient to meet the ergonomic standards and demands of the position.

About Us

Virginia Premier Health Plan, Inc. is a managed care organization which began as a full-service Medicaid MCO in 1995. Partnered with VCU Medical Systems we strive to meet the needs of the underserved and vulnerable populations in Virginia by delivering quality driven, culturally sensitive and financially viable Medicare and Medicaid healthcare programs.  Headquartered in Richmond, VA we also have offices in Roanoke, Tidewater and Bristol with additional satellite locations allowing us to serve over 200,000 members across eighty counties throughout Virginia. 

 

We offer competitive salaries and a comprehensive benefits package to include excellent Medical, Dental and Vision Plans, Tuition Assistance, Infant-At-Work Program, Remote Work options and generous vacation and sick leave policies. Our culture supports an environment where employees can continuously learn and gain professional growth through various development programs, education, exciting projects and career mobility.  

 

All qualified applicants will receive consideration for employment without regard to age, race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. EOE

 

Our mission is to inspire healthy living within the communities we serve!

 

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