Sr Manager Medicaid Programs - Long Term Care

HCSC•Albuquerque, NM

8d•Hybrid

About The Position

This position is responsible for leading and managing the development, implementation, strategic day-to-day administration of managed care operations across business functions (Utilization Management, Quality Management, Project Oversight, Claims, Care Coordination) related to Long Term Care Services and Supports (LTSS). Establish and lead teams in the execution of providing operational support to include oversight, processes, procedures and direction for managed care LTSS requirements, including the Electronic Visit Verification system, LTSS audit activities and assistance with FIDE implementation initiatives. Serve as champion of operations to ensure that operations teams enhance the effectiveness, quality and LTSS objectives of the Medicaid program. This position will assist in the development (along with business leaders and clinical leadership) of processes that ensure operations are compliant with internal and external requirements, including federal and state Medicaid regulations.

Requirements

Bachelors degree in Business or Health Care.
3 years in a leadership/management position to include experience managing diverse groups, multiple priorities/activities effectively and independently
7 years health care experience and knowledge of contract interpretation.
Knowledge of contract provisions relating to home health agencies, nursing facilities, and other Medicaid providers.
Budgeting/accounting experience.
Verbal, written communication and presentation skills to include interaction with all levels of management and/or external customers
Analytical, critical thinking, planning, time management, and organizational skills.
Negotiation skills to request additional revenue, changes to contract parameters and new business.
PC proficiency to include Word, Excel, PowerPoint, and email.
Some travel required.

Nice To Haves

Medicaid Long-Term Care program experience strongly preferred.

Responsibilities

Leading and managing the development, implementation, strategic day-to-day administration of managed care operations across business functions (Utilization Management, Quality Management, Project Oversight, Claims, Care Coordination) related to Long Term Care Services and Supports (LTSS).
Establish and lead teams in the execution of providing operational support to include oversight, processes, procedures and direction for managed care LTSS requirements, including the Electronic Visit Verification system, LTSS audit activities and assistance with FIDE implementation initiatives.
Serve as champion of operations to ensure that operations teams enhance the effectiveness, quality and LTSS objectives of the Medicaid program.
Assist in the development (along with business leaders and clinical leadership) of processes that ensure operations are compliant with internal and external requirements, including federal and state Medicaid regulations.