Director of Managed Care Services

Job Description

Job Description

The Director of Managed Care Services provides strategic, operational and administrative leadership for the agency’s licensed and designated Medicaid programs and services, such as CMHRS (Children's Mental Health Rehabilitation Services) and CORE (Community Orientated Recovery and Empowerment) provided by Office of Mental Health and partnering Medicaid Managed Care Organizations (MCOs).

This role is responsible for the overall direction, quality, compliance, performance and sustainability of these OMH licensed and designated programs. In addition, promote individual and family empowerment, reduction of emergency room visits, individual and family stability through home and community-based services.

This position provides direct supervision to Program Managers as well as serves as an agency leader responsible for driving operational excellence, measurable outcomes, fiscal stewardship and strategic growth.

The Director of Managed Care services works in close partnership with the VP of Integrated Services and collaborates cross functionally with other programs and operations teams to strengthen systems, implement strategic initiatives, maintain compliance and support agency growth while preserving a strong commitment to quality services and meaningful outcomes.

Duties and Responsibilities include the following. Other duties may be assigned.

Strategic Leadership & Program Oversight:

1. Provide strategic and operational leadership for adherence to OMH and MCO guidance and collaboration across programmatic departments, ensuring alignment with agency mission, values, strategic priorities, and long-term organizational goals.

1. Translate agency strategy into integrated program operations, workflows, and implementation priorities across Medicaid/OMH based service areas.
2. Directly supervise, coach, and support Program Managers to ensure accountability, strong leadership, quality implementation, staff development, and consistent program performance.
3. Ensure CMHRS and CORE programs are implemented effectively and achieve intended outcomes while maintaining a strong commitment to family and individual-centered, strengths-based, and trauma-informed practices.

Contract Management, Partnerships & Community Engagement:

1. In partnership with VP of Integrated Services serve as a liaison with Managed Care Organizations, State and Central OMH offices and referral partners to maintain strong, collaborative working relationships and effective service implementation.

1. Represent the agency and department in the broader community, including coalitions, planning efforts, task forces, and interagency collaborations.
2. Ensure contractual obligations, reporting requirements, and performance expectations are achieved.
3. Support and maintain collaborative relationships with stakeholders to improve continuity of care, service access, and systems coordination.

Data, Quality Improvement & Compliance:

1. Develop, monitor, and evaluate program outcomes, quality indicators, contractual deliverables, and key performance indicators (KPIs) across managed care services.

1. Utilize programmatic data analytics to identify trends, gaps, opportunities, and emerging community needs and implement strategies to improve outcomes and quality performance.
2. Maintain oversight of program compliance, incident management, quality assurance activities, documentation standards, audits, and corrective action planning in partnership with the Vice President of Integrated Services and Quality Improvement team.
3. Ensure adherence to agency policies, contractual requirements, and applicable state, and federal regulations.
4. Present program accomplishments, risks, needs, and improvement opportunities to senior leadership through data-informed reporting.

Fiscal Stewardship & Operational Management:

1. Collaborate with the Vice President of Integrated Care and Finance Department to develop, monitor, and manage managed care services budgets and fiscal performance.

1. Monitor program expenditures, staffing patterns, contract utilization, and resource allocation to support financial sustainability and quality service delivery.
2. Participate in budget planning, contract implementation, and program sustainability efforts.
3. Make operational and staffing recommendations to maintain fiscal responsibility while achieving contractual and programmatic goals.

Workforce Leadership, Human Resources & Culture:

1. Partner closely with Human Resources and VP of Integrated Services to support recruitment, onboarding, retention, employee engagement, workforce planning, performance management, and personnel matters.

1. Foster leadership development among Program Managers and support succession planning efforts.
2. Serve as a culture ambassador by proactively supporting, protecting, reinforcing, and modeling agency mission, values, and culture across teams and departments.
3. Promote a culture of accountability, collaboration, inclusion, professionalism, continuous improvement, and psychological safety.
4. Participate actively in agency-wide initiatives, strategic planning efforts, and cross-department collaboration to strengthen organizational alignment.

Qualifications:

• Bachelor’s degree in Social Work, Human Services, Psychology, Counseling, or related field required.
• Minimum 5–7 years’ experience in mental or behavioral health, or related human service settings.
• Minimum 3 years of supervisory or management experience, preferably overseeing leaders or multidisciplinary teams.
• Experience working collaboratively with county systems, OMH, and community stakeholders strongly preferred.
• Strong strategic thinking, relationship-building, communication, organizational, and change management skills.

• Ability to interpret and utilize data to drive decision-making and strengthen outcomes or translate agency strategy into effective program operations, ensuring high quality family and individual centered outcomes, driven service delivery across programs while maintaining fidelity to our licensure and designations, agency mission and our wrap-around principles.