Commonwealth Care Alliance is a rapidly growing nonprofit organization providing integrated health care and social support services to people with complex medical needs. Our patients are seniors and persons with disabilities covered under Medicaid or both Medicaid and Medicare. Our innovative care model is nationally recognized for its effectiveness in improving health outcomes for these vulnerable populations.
Our unique care model is empowering for our employees as well as our members. Whether you are a clinical or administrative professional, all of us at Commonwealth Care Alliance receive the satisfaction of knowing our work truly makes a difference. We enjoy a company culture of passionate advocacy in a supportive work environment with opportunities for growth and learning, competitive salaries, and a generous and comprehensive benefit package.
This position will oversee the organization and delivery of Long Term Services and Supports (LTSS) to Commonwealth Care Alliance (CCA) enrollees. The Director of LTSS is responsible for building and managing a robust strategy for network development, resource allocation and utilization management for long term services and supports for enrollees in CCA’s One Care Program (the Medicare-Medicaid demonstration for people with disabilities between the ages of 21 and 65) and for enrollees age 65 and older in CCA’s Senior Care Organization program. Diversifying service options, assessing alternative payment strategies, and fully understanding the evolving national and state perspectives on managed LTSS care will be key requirements of this role. The Director is expected to work closely with consumer groups, primary care team members and LTSS providers to collaboratively build a responsive, cost effective strategy for maximizing independence, reducing unnecessary facility admissions, and ensuring a system for effective transitions back into the community for those with long term service needs.
The Director of LTSS will work collaboratively with CCA departments, clinical programs and with external organizations to oversee the development of an effective and efficient LTSS service network that meets the needs of CCA members.
The primary responsibility of this role is to ensure that a) internal processes and structures are in place and effectively working and b) external relationships are in place and performing effectively, so that CCA’s enrollees with LTSS needs are appropriately informed of their service options, that their needs are appropriately assessed, and that appropriate services are accessed, coordinated and monitored to ensure quality and maximize independent living in the community, in a cost effective manner. To that end, the Director of LTSS will:
· Build, direct and coordinate CCA’s strategic plan for LTSS development, pricing, assessment, and quality assurance and utilization management in collaboration with other relevant members of the senior management, clinical leadership and cross-functional staff.
· Identify standardized or benchmark assessment tools for various populations in need of LTSS and spear-head processes to determine their utility and/or need for adaptation.
· Track emerging literature and state and federal policy development in this arena to assure ongoing quality improvement within CCA programs.
· Engage external consumer, provider, and state agency personnel in vetting alternative strategies across assessment, service parameters, and quality assurance and utilization management.
· Maintain relationships with state agencies responsible for providing targeted case management, rehab option services, and LTSS to understand changes in state policy and financing that may be relevant to the ICO or SCO programs.
· Provide information and education to CCA staff, clinicians employed by CCA’s clinical groups, supportive care managers, and contracted health home and behavioral health home providers on LTSS options, service delivery models and contractors.
· For the One Care program, oversee the integration of Independent Long Term Services and Supports Coordinators (IL-LTSSC) into the assessment activities and Individual Care Teams of CCA’s clinical groups, Supportive Care Management, and health home networks.
· Design trainings for contracted LTSS coordinators in collaboration with the CCA program training directors.
· Oversee relationships with the Aging Services Area Providers (ASAPs) for both the One Care program and the SCO program, working closely with the respective program leadership.
· Oversee relationships with the providers of Independent LTSS Care Coordinator (IL-LTSSC) services, and work with CCA Provider Network Management staff and other program leadership to maintain and improve relationships.
· Monitor the performance of LTSS service providers and community based organizations (CBOs) under contract with CCA to provide IL-LTSSC and provide feedback on performance that includes Enrollee satisfaction with IL-LTSS Coordinator services and other contracted vendors. Build formal s.
· Develop and implement a formal structure for monitoring LTSS across One Care program and the SCO program, including working with Clinical Operations around due process reviews of LTSS service denials, successes and challenges in LTSS access, and member understanding of the LTS coordinator role.
· Identify gaps in the delivery of IL-LTSSC and work with CCA staff to fill those gaps.
· Serve as a liaison between CCA and LTSS providers to identify areas for improvement or innovation in the delivery of LTSS.
· Work with UM committee to develop ongoing analyses and utilization and cost review oversight activities to assess the extent to which LTSS needs and resulting service authorizations are being systematically addressed across populations; work to identify patterns and trends that provide opportunity for further analyses and improvements.
· Review care team processes and build an understanding of the emerging role of IL-LTSS coordinators in the One Care program and the differential independent living objectives achieved by LTSS authorization.
· Consult with clinical care teams as needed in reviewing LTSS assessments and/or service requests.
· Assess feasibility of introducing “cash and counseling” options for selected CCA members and other innovative programs as alternative delivery of services.
· Bachelor’s degree required; Master’s Degree preferred.
· Minimum of 10 years of increasingly senior experience in LTSS development, management, and or funding and oversight.
· Working knowledge of Medicare and Medicaid (MassHealth); demonstrated knowledge of DMH and DSS systems and waiver programs.
· Experience or knowledge of disability-related medical, behavioral, and long term supports across the spectrum of disability;
· Experience or knowledge of community based services for seniors, including extensive knowledge of the ASAPs and ADRCs.
· Demonstrated knowledge of evolving practice, financing, and policy approaches in the LTSS arena.
· Familiarity with and full support of independent living, recovery, and person-centered planning philosophy and strategies;
· Excellent collaboration and communication skills with the ability to partner effectively across the organization and with external partners to build a robust LTSS capacity.
· Strong strategic thinker and tactical performer
· Strong project management skills with the demonstrated ability to handle multiple projects;
· Demonstrated ability to establish and manage performance and outcome metrics.
Driver’s license preferred.
Commonwealth Care Alliance - 13 months ago