Senior Director, LTSS Service Determinations

Job Summary: The Senior Director, LTSS Service Determinations provides enterprise leadership and strategic oversight for all LTSS Service Determination operations across CareSource 's Medicaid, Dual Eligible, and LTSS markets. This role is accountable for the performance, compliance, quality, and operational effectiveness of Service Determination functions nationwide, with all Service Determination leaders and staff across LTSS markets reporting through this organization. The Senior Director establishes enterprise standards, policies, workflows, and performance expectations to ensure consistent, timely, and regulatory-compliant authorization and service determination decisions across all markets. In partnership with Clinical, Operations, Compliance, Quality, and Market Leadership, this role drives operational excellence, workforce planning, regulatory readiness, process transformation, and scalable growth strategies to support evolving business, member, and regulatory needs. Essential Functions: Enterprise SDT operational accountability across multiple LTSS markets. Oversight of all Service Determination Staff and Leaders. Standardization of policies, processes, and performance management of all SDT teams. Strategic planning and operational transformation responsibilities rather than day-to-day management of a single market. Direct and develop market‑level Service Determination leaders, providing strategic guidance, performance oversight, and cross‑market coordination to drive enterprise consistency, scalability, and sustainable program success. Lead the development and execution of the LTSS service determination operating model, including enterprise workflows, governance, performance frameworks, and future‑state capabilities, in partnership with Product, Clinical, Compliance, and Technology leaders. Ensure timely and accurate determinations in alignment with medical necessity guidelines, benefit rules, and regulatory requirements. Drive consistency in service deter