Manager, Integrated Care Waiver Operations
About The Position
The Manager, Integrated Care Waiver Operations provides leadership and direction to operations staff to ensure departmental and CareSource goals, policies, and standards are met. The role leads regulatory reporting, audit readiness, and compliance activities for Medicare and Medicaid programs, ensuring adherence to state, federal, accreditation, and contractual requirements. It oversees Care Management operations, quality performance, and process improvement initiatives through data analysis, cross-functional collaboration, and strategic oversight to enhance member outcomes, operational efficiency, and regulatory compliance. The manager works with leadership and peer managers to oversee day-to-day operations, team coordination, staffing, training, quality and performance improvement, and member outcomes. The position also collaborates with internal departments, vendors, and community partners; supports care planning and service transitions; and monitors program data, reporting, productivity, financial impacts, and compliance.
Requirements
- Bachelor's degree in Business Administration, Health Care, or a related field.
- Two years of health care experience.
- Previous management experience.
- Intermediate to advanced Microsoft Office skills, including Word and Excel.
- Exceptional written and verbal communication skills.
- Ability to gather work-related information, coordinate workflow, and assist program teams.
- Ability to work with people from varied disciplines and staff levels across departments and interact effectively with all levels of management.
- Flexibility during organizational and business changes.
- Strong analysis, collaboration, interpersonal, and relationship-building skills.
- Ability to work effectively and efficiently within a team.
- Critical listening and thinking, decision-making, and problem-solving skills.
- Customer-service orientation.
- Knowledge of billing practices and budgeting.
- Strong organizational skills and ability to multitask and prioritize.
- Ability to work independently and solve problems using analytical and logical thinking.
- Ability to organize and present basic reports and information to internal stakeholders.
- Ability to define problems, collect data, establish facts, and draw valid conclusions.
- Valid driver's license, vehicle, and verifiable insurance; employment is conditional on an acceptable driver's license record check.
- Annual influenza vaccination is required for designated positions during influenza season (October 1–March 31); employees hired during the season must complete vaccination and verification within 30 days of hire.
Nice To Haves
- Experience in HCBS programs.
- Managed care, Medicaid billing, and/or JFS program experience.
Responsibilities
- Lead monthly, quarterly, and annual CMS, ODM, and other regulatory reporting in collaboration with leadership.
- Oversee Medicare and Medicaid audit preparation and presentations.
- Develop and implement action plans in response to regulatory feedback on reporting and audits, including feedback involving delegated vendors.
- Manage program development and internal and external Care Management processes to support safe, effective service delivery, quality outcomes, and compliance with state and accreditation requirements.
- Develop monthly reports and recommendations based on monitoring findings.
- Conduct monthly and/or quarterly quality reviews with Operations and Case Management teams.
- Work cross-functionally with care coordination to identify process gaps and drive improvements.
- Analyze and report financial savings related to process improvements and financial costs related to outages and process issues.
- Compile reports and departmental communications.
- Participate in strategic planning and implement action plans.
- Build working relationships with IT, Provider Relations, Credentialing, Service Operations, Business Partner Services, CFA, Case Management, and other teams to drive process improvements.
- Review documentation from internal staff and external partners for thoroughness, accuracy, and care management competency.
- Contribute to process development and support care coordination care plans by defining issues, goals, and interventions as appropriate.
- Work with peer managers and the Director on day-to-day operations, team coordination, member outcomes, new staff orientation and scheduling, training, in-servicing, quality and performance improvement, and regulatory and contractual compliance.
- Develop tools for effective care planning and implementation that meet member needs.
- Oversee coordination of services with community partners to maximize appropriate community resources and supports and facilitate effective transitions between care settings.
- Provide updates to the Incident Management program to support investigations related to member health and safety.
- Develop and monitor scheduling, work allocation, and productivity.
- Work with corporate staff to follow up on and review member complaints and grievances.
- Monitor and analyze Integrated Care Management data and reporting.
- Ensure compliance with program descriptions and models of care across all Integrated Care lines of business.
- Perform other job-related duties as requested.
Benefits
- May qualify for a bonus tied to company and individual performance.
- Substantial and comprehensive total rewards package.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Manager
