Provider Operations Manager

the South Dakota State Government•Pierre, SD

3d•Onsite

About The Position

The Provider Operations Manager plays a key role in supporting the administration and oversight of the Home and Community-Based Options and Person-Centered Excellence (HOPE) Waiver and other Home and Community-Based Services (HCBS) programs within the Division of Long Term Services and Supports. The focus of this role is on statewide provider operations, compliance, systems coordination, and building strong relationships with providers across South Dakota. The position leads provider management activities for HCBS providers and serves as a primary operational point of contact between LTSS, providers, Medicaid, and system vendors. Core responsibilities include provider oversight and technical assistance; claims and billing support; Electronic Visit Verification (EVV) monitoring; provider enrollment and compliance; development of policies and procedures; HCBS Settings Final Rule implementation; provider training and communication; and coordination of provider-related systems and operational initiatives. This role works closely with LTSS leadership, Medicaid partners, quality assurance teams, and HCBS providers to ensure compliance with state and federal requirements, strengthen provider capacity, support access to services statewide, and improve operational efficiency. The position also supervises support staff and contributes to division-wide strategic planning, system implementation, and quality improvement efforts.

Requirements

A bachelor's degree in human services, social services, or a related field is preferred
Knowledge or experience in Medicaid claims, provider operations, or comparable program administration
Familiarity with Medicaid Home and Community-Based Services (HCBS) programs, waiver operations, quality assurance expectations, and compliance standards
Knowledge of human services programs, community-based supports, or similar health and social service systems
Understanding of the state and federal rules that guide program operations, service delivery, and provider oversight
Awareness of quality assurance, compliance, and how policies are developed and maintained
Ability to offer clear guidance and support to providers, partners, and stakeholders
Experience coordinating program activities-such as reviewing documents, monitoring performance, and helping ensure compliance
Strength in reviewing processes and policies to find improvements and support effective, efficient practices
Comfortable supervising, mentoring, and supporting team members in a collaborative environment
Strong communication skills, including clear writing, reporting, and positive engagement with internal and external partners
Ability to collect and analyze information to help drive decisions and strengthen service delivery
Use software systems and databases to organize information, track activity, and produce useful reports
Create well-organized, accurate, and timely documentation and correspondence
Understand and apply relevant laws, regulations, and policies in daily work
Make thoughtful, timely decisions and follow through responsibly
Stay organized and flexible while managing multiple priorities and shifting needs
Break down complex policy language and turn it into practical guidance for others
Provide training, technical help, and support to providers and team members
Review service, compliance, or operational data to identify trends and make informed recommendations
Balance several active initiatives at once in a fast-moving environment
Resume attached
Eligible for Veterans' Preference per ARSD 55:10:02:08
All persons hired will be required to verify identity and eligibility to work in the United States and complete an Employment Eligibility Verification, Form I-9
State of South Dakota will be using E-Verify to complete employment eligibility verification upon hire

Responsibilities

Provider oversight and technical assistance
Claims and billing support
Electronic Visit Verification (EVV) monitoring
Provider enrollment and compliance
Development of policies and procedures
HCBS Settings Final Rule implementation
Provider training and communication
Coordination of provider-related systems and operational initiatives
Supervises support staff
Contributes to division-wide strategic planning, system implementation, and quality improvement efforts

Benefits

15 days/120 Hours of Vacation Leave
14 days/112 Hours of Sick Leave
11 Paid Holidays
Employee health insurance includes plan with a $0 premium for employee-only coverage
Flexible Benefits - Dental, Vision, Life Insurance, Critical Illness and more
Paid Parental & Family Medical Leave
6% Fully Matched Retirement Plan
Reduced Tuition for In-State Colleges/Universities
Employee Wellness Program
Continued Education/Training Opportunities