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.
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.
Horizon Blue Cross Blue Shield of New Jersey- the state’s largest and oldest health insurer - is a subsidiary of Horizon Mutual Holdings, Inc., a not-for-profit mutual holding company.
Together with its affiliates, Horizon provides a wide array of medical, dental, vision and prescription insurance products and services. As New Jersey’ health solutions leader, Horizon is transforming healthcare by working with doctors and hospitals to deliver innovative, patient-centered programs that improve quality and lower costs. It is headquartered in Newark, NJ with offices in Wall and Hopewell, NJ.
Horizon serves 3.7 million members including more than 1 million who rely on Medicaid for their health coverage.
