1. Job Title: Acting Director - I-SNP Program
Department: CenterLight Direct Complete (ISNP) Reports To: Vice-President –ISNP
JOB PURPOSE:
On an interim basis, this position oversees the administrative and clinical functions of the CenterLight Healthcare Direct I-
SNP program with responsibility for meeting all CMS regulatory requirements, including the Model of Care, quality
outcomes, budget targets and relationship management in the contracted nursing homes. The Acting Director will assist the
vice president and Business Development staff in outreach efforts and expansion of new business assuming a lead role in the
implementation of the I-SNP model in new facilities. The Acting Director will assure compliance with all CenterLight
Healthcare policies and collaborate and communicate effectively with all stakeholders as required.
JOB RESPONSIBILITIES:
• Translates organizational goals into specific goals and objectives for staff and monitor ISNP outcomes
• Maintains working knowledge of Medicare regulations and the managed care industry
• Reviews and maintains ISNP Policies and Procedures Manual
• Analyze staffing needs based on operational efficiencies and cost effectiveness
• Reviews clinical needs and staffing ratios and makes recommendation for adjustments. Creates buy in by including
clinical manager and NPs.
• Ensures NP Orientation manual is updated and reflects current Policies and Procedures.
• With the Clinical Supervisor, interviews and hires CenterLight Healthcare NPs.
• Ensures that newly hired NPs have been trained in The CenterLight Direct Complete model of care.
• Assures compliance with Centerlight Healthcare Direct I-SNP Model of Care and quality care delivery by
demonstrating a thorough understanding of all requirements, identifying gaps in compliance, developing action plans
that systematically resolves issues and creates a monitoring system to ensure compliance.
• Collaborates with licensed Medicare representatives to ensure CenterLight meets all regulatory compliance and to
promote I-SNP; participates in Outreach, presentations to potential nursing home customers when requested.
JOB DESCRIPTION

2. • Reviews outcome data on Model of Care in contracted nursing homes and develops key strategies to ensure
compliance.
• Educates staff and management of nursing homes and potential members and families on the NP role and improving
health outcomes, including HEDIS, CCIP and QIP programs and other CMS requirements
• Collaborates with other departments – Quality, Member Services, Member Administration, Medical Management –
on policy and procedure developments and CMS submissions
• Monitors quality activities and data collection, analysis related to above initiatives.
• Participates in the development of outcome measures; analyze results and member satisfaction and develop
appropriate interventions.
• Evaluates appropriateness of hospital admissions (avoidable vs. unavoidable) in conjunction with the clinical
managers, NPs and Medical Director through concurrent and retrospective reviews and interviews.
• Collaborates with Medical Management staff and Medical Director on medical necessity, utilization review and prior
authorizations, etc.
• Communicates effectively with superiors, subordinates and peers.
• Oversees education of NPs and facility staff and leads the implementation of strategies/and interventions to reduce
avoidable hospitalizations, such as Interact III, enhanced days, skilled days, evidence based guidelines and advanced
directives for members.
• Participates as a member of the Medicare QA Committee; participates on other committees, as appropriate.
• May participate as a team member on other initiatives.
• Reviews pharmacy reports and ensure appropriate follow-up with Clinical Managers.
QUALIFICATIONS:
Education: Master’s degree in Nursing or related field preferred
Experience: 2-3 years in management/supervisory role with multi-site experience. Managed Care
Experience preferred
License/Registration: NYS licensed registered nurse