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. 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