MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealthhas been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Senior Director of Long Term Care oversees the clinical and administrative operations of the MetroPlusHealth Managed Long Term Care (MLTC) Program, Personal Care Service (PCS) Program and the Medicaid Advantage Plan (MAP). In addition to overseeing staff operations, business planning and budget development, this position serves as the Subject Matter Expert for all services related to Long Term Care. Reporting into the Deputy Chief Medical Officer, this role serves as an integral member of the senior management team.

• Responsible for the daily operations of MetroPlusHealth's Managed Long Term Care, PCS and MAP products
• Plan, direct and set the strategic direction of the long-term care products
• Plan and direct financial and budget activities to fund operations, maximize contracts, and increase efficiency
• Must be and remain current with all applicable MLTC regulatory requirements for marketing, enrollment, operations, billing claims, etc.
• Coordinate implementation of interdepartmental processes (policies and procedures) related to MLTC, MAP and PCS business. Assist the Regulatory Affairs Department with implementing State and federally mandated program changes.
• Oversight of Personal Care Services team as it relates to administering the Personal Care Services benefit for MMC, HIV-SNP and HARP lines of business.
• Oversight of Long-Term Nursing Home placement for all applicable lines of business.
• Oversight of Adult Day Health Care Medical Model benefit for MMC, HIV-SNP and HARP lines of business Ensure compliance with Medicaid Managed Care Personal Care Services regulations.
• Assist the Communications and Sales Department in the development, review and approval of marketing, member and provider-related of other materials. Responsible for ensuring appropriate and complaint materials are produced and disturbed. Work with the Regulatory Affairs Department to receive approval of all materials, as they relate to SDOH.
• Responsible for quality clinical operations of the program.
• Responsible for appropriate care to patients in the program.
• Ensures regular Care Plan Meetings.
• Participates in the preparation of policies and procedures in compliance with relevant regulations.
• Establishes policies to achieve program goals, interprets, and executes those policies to achieve safe and efficient patient care.
• Participate in medical cost discussions and evaluate programs to maximize revenue and decrease costs. Oversee and develop programs to improve and manage benefit delivery
• Actively participate in all the State Department of Health services (SDOH) site visits, audits preparation and in any corrective actions; including review survey documents and training departments.
• Works with the Finance Division in developing financial statements, projections, reimbursement rates, filings and insuring the fiscal visibility of the line of business.
• Works with the Compliance Department to ensure all compliance activities include MLTC products.

• A Master's degree required.
• Five to seven years' experience working in developing long term care products, compliance or a functional are that provides services to MLTC recipients; or
• An equivalent combination of training, education and experience in related fields and educational disciplines; and,
• Through knowledge of State and Federal rules and regulations.
• Minimum of three years of management, operations and or Federal and State regulatory compliance experience.
• Experienced healthcare professional who is able to provide direction in a competitive environment and an evolutionary business.
• Detailed knowledge of healthcare, specifically managed care and insurance regulations.
• Significant and demonstrable experience with Medicaid, Medicare, and Dual Eligible populations and regulations as well as the operational and regulatory requirements around special needs programs
• Must possess a strong understanding of the healthcare industry marketplace via tenure at a managed care or ancillary healthcare services organization
• Requires strong analytical, strategic, and planning skills. Must be able to successfully facilitate sound of business objectives within highly regulated industry.
• Demonstrated ability to analyze a marketing challenge and determine appropriate programs and initiatives in response to research reports.
• Experience in long term managed healthcare or ancillary healthcare services industry (e.g., pharmaceuticals, diagnostics).

Licensure and/or Certification Required:

• N/A

Professional Competencies

• Integrity and Trust
• Customer Service Focus
• Functional/Technical skills
• Written/Oral Communications
• Demonstrated ability to handle multiple tasks simultaneously.
• Exceptional written and oral communication and presentation skills
• Strong interpersonal skills; the leadership ability to work together with others to accomplish the objectives of the business with or without direct line responsibility

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