Director, Medicare/Dual Special Needs Plans

POSITION SUMMARY/RESPONSIBILITIES

Serves as a key leader in driving positive change and fostering a culture of continuous improvement within the organization’s Medicare/D-SNP Model of Care delivery. Responsible for developing, implementing, and supervising initiatives to enhance the quality of care and outcomes for Medicare/D-SNP members while ensuring rigorous compliance with all relevant Centers for Medicare and Medicaid Services (CMS) regulations and guidelines. Collaborates closely with various internal and external stakeholders to achieve organizational performance goals. Tracks improvement efforts and monitors ongoing clinical processes. Provides comprehensive updates to management on the achieved results, ensuring transparency and accountability in driving organizational excellence.

EDUCATION/EXPERIENCE

A Bachelor’s degree in nursing is required, with a preference for a Master’s degree in a health-related field. A thorough knowledge of health care regulations from the Texas Department of Health and Human Services (HHSC) and the Centers for Medicare and Medicaid Services (CMS) and familiarity with various accreditation standards, particularly NCQA and HEDIS, is required. Additionally, expertise in policy formulation, quality management, and process improvement is required. Knowledge of analytical and investigative techniques sufficient to identify current methodologies and evaluate the results' effectiveness is required. Strong project management skills and proficiency in data management are required. A minimum of seven years of managed care experience with working experience in Medicare/D-SNP programs is required. Experience working with elderly and disabled populations is required. Experience with communication alternatives for persons with visual, hearing, and cognitive impairments is highly preferred.

LICENSURE/CERTIFICATION

Current Registered Nurse license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required. Certification by a nationally accrediting body in health care quality is preferred.