LONG TERM SERVICES AND SUPPORTS PROGRAM MANAGER
Job Number: 00120504
Job Posting: May 10, 2017, 9:17:26 AM
Closing Date: May 25, 2017, 12:59:00 AM Full-time A.M. P.M.
Collective Bargaining Unit: None Posting Salary: COMPETITIVE SALARY
Organization: Health and Hospital Systems
Location: Stroger Hospital
Department: Managed Care
The Long Term Services and Supports (LTSS) Program Manager is responsible for leading CountyCare Health Plan's LTSS programs and that of its vendors and providers of Long Term Care (LTC), Home and Community Based Services (HCBS), Money Follows the Person (MFP) and Consent Decree Programs. Collaborates with CountyCare directors, clinical managers, providers, and vendors to achieve appropriate 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 with quality of regulatory requirements of multiple State agencies, federal Center for Medicare and Medicaid Services (CMS) and National Committee on Quality Assurance (NCQA) standards as well as integration of LTSS across key areas of CountyCare including clinical, care management, provider and member relations, utilization management, incidents, grievances and appeals.
This position 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 internal and external stakeholders, including Healthcare and Family Services (HFS), Department of Human Services (OHS), Department on Aging (DoA), and other State agencies, LTSS providers, Community Care Units (CCU), professional and community organizations
- Promotes best practices, integration of LTSS with other health services, community living, member independence, and member-directed care
- Monitors LTSS vendor and provider adherence to applicable State, 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 various sources; corrects discrepancies and communicates accurate caseload data
- Collaborates with CountyCare Provider Relations to ensure LTSS network access for CountyCare members as required by the State and specific waiver requirements
- Identifies and implements opportunities to expand CountyCare's HCBS waiver population and reduce unnecessary LTC admissions and length of stay
- Coordinates all LTSS performance auditing processes: internal and external as required by contract; ensures audit results are distributed and remediation action is completed
- Develops, implements, and maintains LTSS related policies and procedures, operational processes and workflows; communicates and implements all 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 technical interfaces with key vendors (Valence, Consensus, HFS, OHS/Division of Rehabilitation Services (DRS), DoA),
- Reviews, monitors, follow-ups, and distribute emails from the central waiver email inbox
- Initiates development of IT systems and technical interfaces with delegated vendors and State agencies to ensure LTSS documentation, payment, reporting and tracking needs are met and for optimal information sharing between medical, behavioral and LTSS providers and integration of data between delegated vendors to maximize efficient use of health information
- Works with Provider Relations to coordinate semi-annual LTSS provider meetings, at minimum. Develops and assists with LTSS provider communications and materials including overseeing LTSS website content; assist in resolving LTSS provider issues and complaints
- Trains CountyCare staff and network partners on LTSS topics
- Direct participation in CountyCare's in Grievance, Appeals and critical incident processes as subject matter expert on LTSS
- Assist in the monitoring of Fraud, Waste and Abuse related to LTSS services; monitoring for trends and flags in services and payments
- Assist in the development and implementation of processes to ensure to the health, safety and welfare of LTSS members and promote high quality LTSS service provision
- Serve as primary contact and trainer for LTSS related systems including the Electronic Community Care Program Information System (eCCPIS) and WebCM
- Participates in department, oversight committees and workgroups, providing LTSS subject matter insight
- Travels to work sites and LTSS provider locations throughout Cook County
- Performs other duties as assigned
- Reports to Director of Clinical Services, Managed Care
- Bachelor's degree from an accredited college or university is required. (Must provide official transcripts at time of interview.)
- Three (3) years of experience operating/implementing Home and Community Based Services (HCBS) and/or Long-Term Care (LTC) services is required.
- Two (2) years of experience managing staff is required.
- Intermediate proficiency using Microsoft Office is required.
- Must be able to travel to work sites throughout Cook County.
- Master's degree from an accredited college or university is preferred. (Must provide official transcripts at time of interview.)
- Prior experience in Medicaid Managed Care is preferred.
- Prior experience with Long Term Care is preferred.
- Prior experience with HCBS and/or Long Term Care in the State of Illinois is preferred.
MUST MEET ALL REQUIRED QUALIFICATIONS AT TIME OF APPLICATION FILING.
Knowledge, Skills, Abilities and Other Characteristics
- Knowledge of LTSS systems, policies, regulations and goals
- Knowledge of managed care and health system goals and tends
- Knowledge of health, safety and welfare regulations, government agencies and professional organizations related to LTSS program
- Knowledge, Skills. Abilities and Other Characteristics continued
- Exceptional program development, management, and leadership skills
- Excellent verbal and written communication skills necessary to communicate with all levels of staff and a patient population composed of diverse cultures and age groups
- Strong interpersonal skills to build relationships, negotiate and collaborate with individuals, organizations and key stakeholders
- Strong initiative to innovate, improve health outcomes for individuals and populations and implement integration of behavioral and physical health care
- Demonstrated analytical, problem-solving, critical thinking, decision making and conflict management resolution skills
- Ability to conduct activities in accordance with CCHHS privacy policies and provide leadership regarding confidentiality requirements for LTSS services
- Ability to prioritize, plan and organize projects to meet deadlines in a fast paced and stressful environment
- Ability to function autonomously and as a team member in a multidisciplinary team
- Must be able to travel to work sites throughout Cook County
When applying for employment with the Cook County Health & Hospitals System, preference is given to honorably discharged Veterans who have served in the Armed Forces of the United States for not less than 6 months of continuous service
To take advantage of this preference a Veteran must:
Meet the minimum qualifications for the position.
Identify self as a Veteran on the employment application by answering yes to the question by answering yes to the question, Are you a Military Veteran?
Attach a 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 one with the latest date. Coast Guard must submit a certified copy of the military separation from either the Department of Transportation (Before 9/11) or the Department of Homeland Security (After 9/11). Discharge papers must list and Honorable Discharge Status. Discharge papers not listing an Honorable Discharge Status are not acceptable
A copy of a valid State ID Card or Driver's License which identifies the holder of the ID as a Veteran, may also be attached to the application at time of filing.
If items are not attached, you will not be eligible for Veteran Preference
VETERANS MUST PROVIDE ORIGINAL APPLICABLE DISCHARGE PAPERS OR APPLICABLE STATE ID CARD OR DRIVER'S LICENSE AT TIME OF INTERVIEW.
- Medical, Dental, and Vision Coverage
- Basic Term Life Insurance
- Pension Plan and Deferred Compensation Program
- Employee Assistance Program
- Paid Holidays, Vacation, and Sick Time
- You may also qualify for the Public Service Loan Forgiveness Program (PSLF)
For further information on our excellent benefits package, please click on the following link: http://www.cookcountyrisk.com/
Degrees awarded outside of the United States with the exception of those awarded in one of the United States' territories and Canada must be credentialed by an approved U.S. credential evaluation service belonging to the National Association of Credential Evaluation Services (NACES) or the Association of International Credential Evaluators (AICE). Original credentialing documents must be presented at time of interview.
*Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.
*CCHHS is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.
COOK COUNTY HEALTH AND HOSPITAL SYSTEM IS AN EQUAL OPPORTUNITY EMPLOYER