LLTSS Director - Planning & Strategy Lead (Strategy & Prog Dev Director)

LTSS Director - Planning & Strategy Lead (Strategy & Prog Dev Director)

Preferred Location: Ohio. This position is hybrid and will require the associate to report to 1 of 4 Elevance office locations at least 1-2 times per week. The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations within the state of Ohio.

The LTSS Director - Planning & Strategy Lead is responsible for providing strategic leadership and oversight for the implementation and administration of the Next Generation MyCare Ohio Program, coordinating with internal partners to ensure growth and compliance.   

How will you make an impact: 

• Accountable for implementing and overseeing clinical management functions for members receiving LTSS, including assessments, service planning, care coordination, transition planning, member appeals, state hearings, and member and caregiver education and training. 

• Responsible for monitoring LTSS performance across financial, clinical, LTSS network, and operational KPIs, integrating new regulatory requirements within the OH MyCare Program. 

• Lead Care Coordination and LTSS Provider Relations to execute initiatives/innovations and trend mitigation, ensuring compliance with program requirements, rules, and regulations. 

• Implement and oversee provider management functions for LTSS services, including provider enrollment, orientations, monitoring, and operating an incident management, investigation, and response system. 

• Develop and oversee program policies, procedures, and protocols in accordance with federal and state requirements, overseeing the member grievance process. 

• Work closely with Medical Officers, Quality Directors, Providers, and other partners to improve coordination and engage with LTSS NF and HCBS providers, community partners, and other advocates to solicit feedback. 

• Establish relationships to drive collaboration and satisfaction with the administration of the OH MyCare Program. 

Minimum Requirements: 

• Requires a BA/BS degree in a related field and a minimum of 10 years of related experience including 5 years of leadership experience; or any combination of education and experience, which would provide an equivalent background. 

Preferred Skills, Capabilities and Experiences: 

• Licensed Registered Nurse (RN) or Licensed Independent Social Worker (LISW) for the state of Ohio strongly preferred. 

• Master’s degree in a health-related field and 5+years leading Medicaid programs supporting LTSS waiver populations such as older adults and/or individuals with disabilities, with preferred experience delivering home- and community-based services in Ohio. 

• Extensive knowledge of Medicaid policy, with demonstrated experience in promoting person-centered planning, transitions of care, diversion from higher levels of care, network development, value-based payment arrangements and monitoring quality of care strongly preferred. 

• Experience interfacing and partnering across all lines of businesses. 

• Exceptional presentation skills with the ability to convey complex information clearly and persuasively. 

• Proficiency in Excel at an intermediate to advanced level is preferred.