Director MLTSS Operations

Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health.  For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience.  Our members are our neighbors, our friends, and our families.  It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds. 

About the Role

This role is responsible for the strategic leadership, performance oversight, and operational execution of the Managed Long-Term Services and Supports (MLTSS) program. It ensures the delivery of high-quality, compliant, and member-centered services across home- and community-based care, as well as facility-based settings (e.g., nursing homes and assisted living facilities).

The role partners cross-functionally with internal stakeholders and external providers to drive program effectiveness, maintain regulatory compliance, and optimize member outcomes, while leading a high-performing operations team that supports care management delivery.

What You'll Do

Key Responsibilities

Strategic Leadership & Program Oversight

• Develop and execute the strategic direction for MLTSS Operations aligned with Government Programs and enterprise priorities.

• Ensure delivery of high-quality, cost-effective, and member-centric services across the MLTSS continuum.

• Drive continuous improvement initiatives to enhance service delivery, operational efficiency, and member satisfaction.

Regulatory Compliance & Program Integrity

• Ensure full compliance with NJ MLTSS contract requirements, state and federal regulations, and accreditation standards.

• Oversee program audits, readiness activities, and corrective action plans.

• Develop and maintain policies and procedures aligned with regulatory requirements.

Operations & Care Coordination Excellence

• Oversee care coordination activities across multiple care settings to ensure seamless member experiences.

• Ensure timely and accurate completion of member assessments in accordance with regulatory guidelines.

• Lead the non-clinical operations team supporting authorization management and provider outreach.

Provider & Stakeholder Collaboration

• Partner with Provider Contracting and Network teams to maintain an adequate and high-performing LTCSS network.

• Collaborate with internal stakeholders (Medical Economics, Clinical, Compliance, Analytics) and external partners to drive program outcomes.

• Represent MLTSS Operations in enterprise and regulatory workgroups.

Data, Performance & Continuous Improvement

• Leverage data insights to monitor program performance, identify trends, and drive evidence-based decision-making.

• Collaborate with analytics teams to develop reporting on population health outcomes and operational performance.

• Identify operational risks and implement mitigation and process improvement strategies.

People Leadership & Talent Development

• Lead, develop, and retain a high-performing team, fostering a culture of accountability, collaboration, and continuous learning.

• Oversee staff training, development, and performance management processes.

• Assess workforce capabilities and implement targeted learning and development initiatives.

Disclaimer:

This description is intended to describe the general scope and level of work performed and is not an exhaustive list of all responsibilities, duties, or qualifications.

What You Bring

Education/Experience:

• High School Diploma/GED required.

• Bachelor’s degree in Healthcare Administration, Nursing, Public Health, or related field preferred.

Experience

• 7–10+ years of progressive leadership experience in managed care, long-term services and supports, or healthcare operations.

• Demonstrated experience leading complex, regulated programs (Medicaid/MLTSS strongly preferred).

• Experience managing cross-functional teams and driving enterprise initiatives.

Skills & Competencies

• Deep understanding of MLTSS programs, home and community-based services, and long-term care delivery models

• Strong knowledge of regulatory and compliance requirements

• Strategic thinking and execution capabilities

• Data-driven decision-making and performance management

• Executive-level communication and stakeholder management

• Change leadership and continuous improvement mindset

Leadership Expectations

• Enterprise Mindset: Aligns MLTSS operations with broader organizational strategy and priorities

• Collaboration: Builds strong partnerships across clinical, operational, and external partners

• Accountability: Drives measurable outcomes and ensures program integrity

• Innovation: Identifies opportunities to modernize care delivery and improve member experience

• People Focus: Develops talent and fosters an engaged, high-performing team

Work Environment & Scope

• Operates within Government Programs, supporting the MLTSS population across multiple care settings

• Oversee both clinical-adjacent operations and non-clinical support functions

• Responsible for program performance, regulatory compliance, and operational excellence

Why Horizon?

At Horizon, you’ll do meaningful work that directly improves lives—while being supported by a mission‑driven organization that values expertise, collaboration, and growth.  We believe that when our people thrive, our communities do too.  If you are passionate about making an impact, we’d love to hear from you!

Salary Range:

$138,000 - $188,370

​This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity.  This range has been created in good faith based on information known to Horizon at the time of posting.  Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Disclaimer:

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware. This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law.  Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.