Operations Manager Medicaid Health Home

Bassett Healthcare Network•Village of Cooperstown, NY

About The Position

The Operations Manager provides operational leadership and oversight for the organization’s Medicaid Health Home administrative functions and responsibilities to the New York State Department of Health (NYSDOH), internal Care Management Agency (CMA) operations, and the In-Person Assistor (IPA) grant program, which helps uninsured individuals access coverage. The role also oversees operational performance and partner coordination under contracts with Managed Care Organizations (MCOs) and external CMAs, within the authority assigned to the position. It translates organizational, regulatory, contractual, and program requirements into operational plans, workflows, performance expectations, and continuous improvement activities. The position oversees day-to-day functioning and performance, including workforce and capacity planning, enrollment and outreach, documentation and reporting, billing and reimbursement, quality and audit readiness, contract deliverables and partner performance, grant deliverables, and operational and financial sustainability. The Operations Manager leads assigned supervisors and staff, coordinates with internal departments and external stakeholders, and identifies and addresses operational risks and performance gaps. The role oversees Health Home program administration and NYSDOH coordination; internal CMA operations; and implementation of the IPA grant program. It also manages workforce planning and development, operational administration and monitoring of MCO and external CMA relationships, financial and resource management, quality and compliance activities, continuous improvement, and communication and collaboration across the organization and with stakeholders. The position performs other related duties as requested or directed. The position requires a bachelor’s degree, though experience may be considered in lieu of education; at least five years of management or supervisory experience; at least two years of Health Home Care Management or Administration experience; and a New York State driver’s license. Occasional travel may be required. The work is primarily sedentary and includes the physical activities described in the posting.

Requirements

Bachelor’s degree required; experience may be considered in lieu of education.
Minimum five years of management or supervisory experience.
Minimum two years of Health Home Care Management or Administration experience.
New York State driver’s license required.
Skills in analysis and evaluation, project management and planning, leadership, coaching, conflict resolution, policy making, data management, computer use, resourcefulness, communication, people management, organizing and categorizing records, multitasking, and time management.
Occasional travel may be required.
Sedentary work involving exertion of up to 10 pounds occasionally and negligible force frequently or constantly; sitting most of the time, with walking or standing only occasionally.
Occasional balancing, climbing, crouching, grasping, kneeling, lifting, pulling, pushing, reaching, repetitive motion, standing, stooping, visual acuity, and walking.
Frequent hearing and talking; constant typing/clerical work, dexterity, and seeing/monitor/computer use.

Responsibilities

Oversee operational administration of the Medicaid Health Home program and coordinate activities supporting the organization’s responsibilities to NYSDOH.
Maintain working knowledge of applicable laws, regulations, guidance, contractual requirements, and program standards relevant to assigned responsibilities.
Coordinate preparation, review, submission, and follow-up of required program reports, data, documentation, and deliverables.
Monitor program performance and operational requirements; identify gaps and coordinate corrective action and escalation.
Develop, maintain, and improve program policies, procedures, workflows, and operational controls.
Coordinate audit readiness, record reviews, information requests, and follow-up on findings or corrective action plans.
Coordinate among Health Home administration, internal departments, leadership, and external stakeholders; support maintenance of program designation, approvals, and operational documentation.
Oversee internal CMA day-to-day operations, including referral management, outreach, enrollment, care navigation, documentation, and operational follow-through.
Establish and monitor operational expectations, performance measures, and workflows supporting member engagement, enrollment, service delivery, documentation, and retention.
Oversee staffing and capacity planning, caseload distribution, workload management, and resource allocation.
Direct and support supervisors and assigned staff; delegate responsibilities, monitor performance, and address operational barriers.
Monitor enrollment, caseload, documentation, billing, reimbursement, outstanding billing, disenrollment, and other operational indicators; develop action plans for performance gaps.
Coordinate with billing, finance, information technology, quality, compliance, and other departments to resolve operational, system, documentation, eligibility, workflow, and reimbursement issues.
Support consistent care management processes, including person-centered planning and documentation, while distinguishing operational oversight from clinical or direct-service responsibilities.
Develop and implement staff orientation, training, competency support, and process updates in collaboration with subject matter experts and relevant departments.
Monitor CMA quality and audit findings and coordinate improvement activities, staff education, and follow-up.
Evaluate opportunities to improve appropriate CMA enrollment, efficiency, member access, and financial sustainability.
Oversee operational implementation of the IPA grant program, including staffing, outreach, workflows, training, and operational support.
Monitor IPA program activity, measures, deliverables, reporting, documentation, resource use, and fiscal or administrative requirements; coordinate corrective actions as needed.
Coordinate with grant administrators, internal departments, community organizations, and other stakeholders to support insurance enrollment assistance and program effectiveness.
Ensure IPA staff understand program expectations, procedures, documentation standards, and escalation processes.
Develop and recommend staffing and coverage plans aligned with demand, service expectations, resources, and approved budgets.
Participate in recruitment, interviewing, onboarding, orientation, retention, and workforce development for assigned personnel.
Set performance expectations, provide feedback, and address performance or conduct concerns in accordance with organizational policy.
Delegate work, establish priorities and schedules, and ensure staff have the training, tools, and information needed to perform their duties.
Promote staff development, collaboration, accountability, and a respectful, patient-centered work environment.
Oversee operational administration and monitoring of contracts and working relationships with MCOs and external CMA partners.
Monitor partner performance against contract requirements, service expectations, deliverables, reporting timelines, and performance measures; coordinate follow-up on gaps.
Coordinate with partners and internal teams to resolve operational issues involving referrals, enrollment, member assignment, documentation, billing, reporting, and care coordination workflows.
Track contract obligations, partner performance concerns, deliverables, action items, and issue resolution; escalate material risks, recurring deficiencies, or potential noncompliance.
Coordinate routine operational communications and meetings with MCOs and external CMA partners.
Provide operational input for contract development, review, renewal, amendment, and implementation; coordinate with contract owners and responsible departments.
Coordinate partner performance reviews and corrective action follow-through with appropriate leaders and contract owners.
Monitor operational and financial performance for assigned program areas with Finance and program leadership.
Review financial and operational data to identify trends, risks, opportunities, and actions to improve efficiency and sustainability.
Assist with developing, monitoring, and managing operational budgets, staffing plans, and resource projections within delegated authority.
Coordinate operational matters with Finance, billing, procurement, vendors, and other departments.
Identify opportunities to improve revenue capture, enrollment and billing workflows, resource utilization, and cost effectiveness.
Promote consistent application of approved policies, procedures, and program standards.
Use operational data, audits, staff feedback, and stakeholder input to identify process deficiencies and improvement opportunities.
Develop, implement, and monitor corrective action plans and process improvements within the position’s scope.
Coordinate with subject matter experts in Quality, Compliance, Legal, Finance, Information Technology, and other areas when specialized review or decisions are needed.
Escalate potential regulatory, operational, financial, privacy, or service-delivery risks to appropriate leadership in a timely manner.
Provide leadership with timely and accurate updates on performance, risks, barriers, staffing, finances, and improvement initiatives.
Communicate operational changes, requirements, and expectations to staff and stakeholders.
Represent assigned program areas in internal meetings and external forums as delegated.
Build working relationships across departments, affiliates, community partners, and other stakeholders to resolve issues and support program objectives.
Perform other related duties as requested or directed.