Director of Managed Care

Job Description

Job Description

POSITION SUMMARY:

Provides strategic leadership and direction for the MI Choice Waiver, Veterans Directed Care, and other managed care programs. Responsible for program performance, contract compliance, staff leadership, and alignment with agency mission and strategic goals. Ensures high-quality service delivery, financial sustainability, operational efficiency, and the integration of person-centered principles and best practices across programs to achieve optimal outcomes.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

· Leads strategic planning, growth, and innovation across service line programs, developing and implementing long-term plans, policies, procedures, and program enhancements that align with best practices, regulatory requirements, and organizational goals.

· Serves as a key member of the leadership team, contributing to agency-wide initiatives and strategic planning.

· Works with agency leadership to expand access to services, optimize care management models, and align with evolving healthcare trends.

· Advocates for policy and regulatory changes at the state and federal levels that impact managed care services.

· Ensures compliance with all Medicaid MI Choice Waiver, Dual Special Needs Plan, Veterans Directed Care and other managed care program regulations, policies, and reporting requirements.

· Develops, monitors, and refines performance metrics and continuous quality improvement strategies to assess and improve clinical outcomes and service delivery satisfaction and efficiency.

· Works with Quality and Compliance to implement and refine quality management plans and ensure adherence to all regulatory, audit, and accreditation requirements.

· Provides fiscal oversight for service line programs, ensuring optimal participant outcomes and financial sustainability through effective cost containment and utilization management strategies.

· Works with Financial Services to develop and manage the program’s budget, ensuring efficient allocation of resources and adherence to fiscal policies.

· Evaluates service delivery trends and implements data-driven improvements to enhance participant outcomes.

· Leads service line workforce planning and development efforts to optimize staffing structure and model of care delivery, ensuring operational efficiency, excellence in service delivery, and capacity to meet service demands.

· Develops and implements staff training and professional development initiatives in collaboration with agency leadership.

· Serves as the primary liaison with state agencies, Veterans Administration, Managed Care Organizations, and others as appropriate, representing the agency in policy discussions, advocacy efforts, and network collaborations.

· Strengthens partnerships to enhance participant services, improve referral pathways, and support program sustainability and mission impact.

· Works with staff responsible for provider network development to align quality initiatives with home and community-based service delivery to enhance service coordination, improve participant outcomes, and ensure compliance with regulatory and contractual requirements.

· Leads by example in fostering a workplace culture that reflects the agency’s core values, ensuring a supportive, inclusive, and mission-driven environment where staff are empowered, collaboration is encouraged, and excellence in customer service is prioritized.

· Other duties as assigned.

SUPERVISORY RESPONSIBILITIES

Directly supervises the managerial, supervisory, administrative and other designated staff within the service line. Responsible for setting performance expectations, supporting leadership development, and guiding team members to align operations with strategic goals. Carries out supervisory responsibilities in accordance with agency's policies and applicable laws. Responsibilities include interviewing, hiring, and training employee(s); planning, assigning and directing work; appraising performance; rewarding and disciplining employee(s); addressing complaints and resolving problems.

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must demonstrate strong leadership, strategic thinking, and comprehensive knowledge of long-term care systems and managed care operations. Must possess the ability to interpret and apply complex regulations, manage multidisciplinary teams, and balance mission alignment with contractual and financial accountability. Must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Some local travel required; will need reliable transportation.

EDUCATION AND/OR EXPERIENCE:

Bachelor’s degree or higher in healthcare administration, public health, social work, nursing, human services, related field or equivalent experience required. Minimum of 5-7 years of progressively responsible experience in long-term services and supports, Medicaid waiver programs, home and community-based services, or managed care, including at least 2-3 years in a leadership role strongly preferred.

REASONING ABILITY:

Must be able to analyze complex systems, identify trends, and make strategic decisions. Ability to manage ambiguity, assess risk, synthesize information from diverse sources, and implement effective solutions across program and operational areas. Ability to define problems, collect data, establish facts, and draw valid conclusions.

OTHER SKILLS AND ABILITIES:

Strong interpersonal and leadership skills, with the ability to build consensus, coach emerging leaders, and represent the agency in high-level stakeholder discussions. Proficient in interpreting policy, developing initiatives, and leveraging data for strategic decision-making.

LANGUAGE SKILLS:

Excellent verbal and written communication skills required. Must be able to prepare executive-level reports, draft policy recommendations, and communicate effectively with external stakeholders, funders, and multidisciplinary teams.

MATHEMATICAL SKILLS:

Ability to work with financial data, budgets, utilization reports, and forecasting tools. Must be able to analyze and interpret numeric data for cost-containment, program evaluation, and strategic planning.

PHYSICAL DEMANDS:

The physical demands described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is regularly required to communicate and express oneself. The employee frequently operates a computer, using other tools and controls, and positioning oneself to operate computer and other office equipment. The employee is frequently required to remain in a stationary position, and then occasionally move about inside the office to access workstation, office equipment, and file storage areas, etc. The employee must be able to travel in all kinds of weather.

While performing the duties of this job the employee may need to regularly move up to 10 pounds and frequently move up to 15 pounds. Specific vision abilities for this job may include close vision, depth perception, distance vision, and the ability to adjust focus.

Benefits:

• 403(b)
• 403(b) matching
• Dental insurance
• Flexible schedule
• Flexible spending account
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Vision insurance

Region IV, Area Agency on Aging, Inc., is a private, not-for-profit organization. Established in 1974 to develop age-supportive services. We play a major role in planning, funding, and delivering a host of services. Empowerment and consumer independence are driving themes behind our efforts. Designated by the State of Michigan to receive federal Older Americans Act funds of planning and development, the corporation manages an array of government contracts for service delivery in southwest Michigan. Our primary service area includes Berrien, Cass, and Van Buren counties.

Company Description

Region IV, Area Agency on Aging, Inc., is a private, not-for-profit organization. Established in 1974 to develop age-supportive services. We play a major role in planning, funding, and delivering a host of services. Empowerment and consumer independence are driving themes behind our efforts. Designated by the State of Michigan to receive federal Older Americans Act funds of planning and development, the corporation manages an array of government contracts for service delivery in southwest Michigan. Our primary service area includes Berrien, Cass, and Van Buren counties.