Director of Managed Care

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.

• 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.

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.

To perform this job successfully, an individual must demonstrate strong leadership, strategic thinking, and comprehensive knowledge of long‑term care systems…