LONG TERM SERVICES AND SUPPORTS PROGRAM MANAGER 00120504
: May 10, 2017, 8:17:26 AM : May 24, 2017, 11:59:00 PM Full-time A.M. P.M.
Collective Bargaining Unit: None Posting Salary: COMPETITIVE SALARY
: Health and Hospital Systems
Department: Managed Care
TheLong Term Services and Supports (LTSS) Program Manager is responsible forleading CountyCare Health Plan's LTSS programs and that of its vendors andproviders of Long Term Care (LTC), Home and Community Based Services (HCBS),Money Follows the Person (MFP) and Consent Decree Programs. Collaborates withCountyCare directors, clinical managers, providers, and vendors to achieveappropriate and effective utilization of LTSS to maximize quality of life,cost effectiveness and opportunities for member independence in the community.Serves as point of contact and provides expertise to ensure compliance withquality of regulatory requirements of multiple State agencies, federal Centerfor Medicare and Medicaid Services (CMS) and National Committee on QualityAssurance (NCQA) standards as well as integration of LTSS across key areas ofCountyCare including clinical, care management, provider and member relations,utilization management, incidents, grievances and appeals.
Thisposition is exempt from Career Service under the CCHHS Personnel Rules.
- Serves as primary contact and lead on LTSS services,processes, state and federal rules and regulations pertaining to LTSS.Maintains understanding and keeps abreast of LTSS program and rule changes
- Develops and maintains effective relationships with internaland external stakeholders, including Healthcare and Family Services (HFS),Department of Human Services (OHS), Department on Aging (DoA), and other Stateagencies, LTSS providers, Community Care Units (CCU), professional andcommunity organizations
- Promotes best practices, integration of LTSS with otherhealth services, community living, member independence, and member-directedcare
- Monitors LTSS vendor and provider adherence to applicableState, federal rules and regulations; develops and initiates corrective action,as necessary; coordinates and implements the LTSS provider evaluation process
- Manages and validates LTSS caseload data from varioussources; corrects discrepancies and communicates accurate caseload data
- Collaborates with CountyCare Provider Relations to ensureLTSS network access for CountyCare members as required by the State andspecific waiver requirements
- Identifies and implements opportunities to expandCountyCare's HCBS waiver population and reduce unnecessary LTC admissions andlength of stay
- Coordinates all LTSS performance auditing processes: internaland external as required by contract; ensures audit results are distributed andremediation action is completed
- Develops, implements, and maintains LTSS related policies andprocedures, operational processes and workflows; communicates and implementsall LTSS policy changes
- Designs and/or approves reports, metrics, and data analyses,including those produced by vendors to measure LTSS utilization and outcomes,trends, contract and regulatory compliance, member and provider satisfaction,and quality improvement
- Informs and assists in the implementation of the technicalinterfaces with key vendors (Valence, Consensus, HFS, OHS/Division ofRehabilitation Services (DRS), DoA),
- Reviews, monitors, follow-ups, and distribute emails from thecentral waiver email inbox
- Initiates development of IT systems and technical interfaceswith delegated vendors and State agencies to ensure LTSS documentation,payment, reporting and tracking needs are met and for optimal informationsharing between medical, behavioral and LTSS providers and integration of databetween delegated vendors to maximize efficient use of health information
- Works with Provider Relations to coordinate semi-annual LTSSprovider meetings, at minimum. Develops and assists with LTSS providercommunications and materials including overseeing LTSS website content; assistin resolving LTSS provider issues and complaints
- Trains CountyCare staff and network partners on LTSS topics
- Direct participation in CountyCare's in Grievance, Appealsand critical incident processes as subject matter expert on LTSS
- Assist in the monitoring of Fraud, Waste and Abuse related toLTSS services; monitoring for trends and flags in services and payments
- Assist in the development and implementation of processes toensure to the health, safety and welfare of LTSS members and promote highquality LTSS service provision
- Serve as primary contact and trainer for LTSS related systemsincluding the Electronic Community Care Program Information System (eCCPIS) andWebCM
- Participates in department, oversight committees andworkgroups, providing LTSS subject matter insight
- Travels to work sites and LTSS provider locations throughoutCook County
- Performs other duties as assigned
- Reportsto Director of Clinical Services, Managed Care
- Bachelor'sdegree from an accredited college or university is required. (Must provideofficial transcripts at time of interview.)
- Three (3) years of experience operating/implementingHome and Community Based Services (HCBS) and/or Long-Term Care (LTC) services is required.
- Two (2) years of experience managing staff isrequired.
- Intermediateproficiency using Microsoft Office isrequired.
- Mustbe able to travel to work sites throughout Cook County.
- Master's degree from an accreditedcollege or university is preferred.(Must provide official transcripts attime of interview.)
- Prior experience in Medicaid Managed Careis preferred.
- Prior experience with Long Term Careis preferred.
- Prior experience with HCBS and/or Long Term Care in the State of Illinoisis preferred.
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OFAPPLICATION FILING.
Knowledge,Skills, Abilities and Other Characteristics
- Knowledgeof LTSS systems, policies, regulations and goals
- Knowledgeof managed care and health system goals and tends
- Knowledgeof health, safety and welfare regulations, government agencies and professionalorganizations related to LTSS program
- Knowledge,Skills. Abilities and Other Characteristics continued
- Exceptionalprogram development, management, and leadership skills
- Excellentverbal and written communication skills necessary to communicate with alllevels of staff and a patient population composed of diverse cultures and age groups
- Stronginterpersonal skills to build relationships, negotiate and collaborate withindividuals, organizations and key stakeholders
- Stronginitiative to innovate, improve health outcomes for individuals and populationsand implement integration of behavioral and physical health care
- Demonstratedanalytical, problem-solving, criticalthinking, decision making and conflict management resolution skills
- Abilityto conduct activities in accordance with CCHHS privacy policies and provideleadership regarding confidentiality requirements for LTSS services
- Abilityto prioritize, plan and organize projects to meet deadlines in a fast paced andstressful environment
- Abilityto function autonomously and as a team member in a multidisciplinary team
- Mustbe able to travel to work sites throughout Cook County
When applyingfor employment with the Cook County Health & Hospitals System, preferenceis given to honorably discharged Veterans who have served in the Armed Forcesof the United States for not less than 6 months of continuous service
Totake advantage of this preference a Veteran must:
Meetthe minimum qualifications for the position.
Identifyself as a Veteran on the employment application by answering yes to thequestion by answering yes to the question, "Are you a Military Veteran?"
Attacha copy of their DD 214, DD 215 or NGB 22(Notice of Separation at time of application filing. Please note: If you have multiple DD214s, 215s, or NGB 22S, Please submit the onewith the latest date. Coast Guard mustsubmit a certified copy of the military separation from either the Departmentof Transportation (Before 9/11) or the Department of Homeland Security (After9/11). Discharge papers must list andHonorable Discharge Status. Discharge papersnot listing an Honorable Discharge Status are not acceptable
Acopy of a valid State ID Card orDriver's License which identifies the holder of the ID as a Veteran, mayalso be attached to the application at time of filing.
If items are not attached,you will not be eligible for Veteran Preference
VETERANS MUST PROVIDEORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'SLICENSE AT TIME OF INTERVIEW.
- Medical, Dental, and VisionCoverage
- Basic Term Life Insurance
- Pension Plan and DeferredCompensation Program
- Employee Assistance Program
- Paid Holidays, Vacation, andSick Time
- You may also qualifyfor the Public Service Loan Forgiveness Program (PSLF)
Forfurther information on our excellent benefits package, please click on thefollowing link: http://www.cookcountyrisk.com/
Degreesawarded outside of the United States with the exception of those awarded in oneof the United States' territories and Canada must be credentialed by anapproved U.S. credential evaluation service belonging to the NationalAssociation of Credential Evaluation Services (NACES) or the Association ofInternational Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
*Please note all offers ofEmployment are contingent upon the following conditions: satisfactoryprofessional & employment references, healthcare and criminal backgroundchecks, appropriate licensure/certifications and the successful completion of aphysical and pre-employment drug screen.
*CCHHS is strictlyprohibited from conditioning, basing or knowingly prejudicing or affecting anyterm or aspect of County employment or hiring upon or because of any politicalreason or factor.
COOKCOUNTY HEALTH AND HOSPITAL SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER