Manager, Integrated Care Waiver Operations - Must Live in Ohio

Job Summary:

Manager, Integrated Care Waiver Operations is responsible to provide leadership and direction to operations staff to ensure the goals, policies, and standards of the department and CareSource are met. This position leads regulatory reporting, audit readiness, and compliance activities for Medicare and Medicaid programs while ensuring adherence to state, federal, accreditation, and contractual requirements. This position 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.

Essential Functions: Responsible with leadership for CMS, ODM and regulatory reporting monthly, quarterly, and yearly

Oversight for Medicare and Medicaid audit preparation and presentation

Responsible to development and implementation of action plans related to regulatory feedback on reporting and/or audits, including for delegated vendors

Actively manage the program development and internal/external Care Management processes to ensure safe and effective service delivery, quality outcomes, and compliance with all state and accreditation requirements

Generate and develop monthly reporting and recommendations based on findings from monitoring activities

Conduct monthly and/or quarterly quality reviews with the Operations and Case Management team

Work cross-functionally with care coordination team to identify process gaps and drive improvements

Analyze and report financial savings related to process improvements

Report financial cost related to outages and process issues

Compile reports and departmental communications

Participate in strategic planning and implement action plans

Build strong working relationships with IT, Provider Relations, Credentialing, Service Operations, Business Partner Services, CFA, Case Management, and any other area in which collaboration will be essential for driving process improvements

Review documentation gathered by internal staff and external partners to ensure thoroughness, accuracy and care management competency

Contribute to the ongoing development of processes and support of care coordination care plans, defining specific issues, goals and interventions as appropriate

Working with peer Managers and Director, responsible for day-to-day operations, including, team coordination and member outcomes, new staff orientation and scheduling, training, in-servicing, quality and performance improvement, regulatory and contractual compliance

Develop tools to provide effective care planning and implementation meeting member needs

Oversee the coordination of services with community partners to maximize utilization of appropriate community resources and supports, and assure effective and appropriate transitions between settings of care

Provides updates to Incident Management program to support the investigation process related to member health and safety

Develop and monitor scheduling/work allocation and productivity

Work with corporate staff in the follow up and review of member complaints and grievances

Monitor and analyze Integrated Care Management data and reporting

Assure overall compliance with the program descriptions/models of care for all Integrated Care lines of business

Perform any other job related duties as requested.

Education and Experience: Bachelor's degree in Business Administration, Health Care or other related field required

Two (2) years of health care experience required

Experience in HCBS programs preferred

Previous management experience required

Managed care, Medicaid Billing and/or JFS Program experience preferred

Competencies, Knowledge and Skills: Intermediate to Advanced Microsoft Office skills: Word and Excel

Exceptional written and verbal communication skills

Ability to gather work related information and coordinate workflow and assist programs teams

Ability to work with a variety of disciplines and levels of staff across departments

Proven ability to effectively interact with all levels of management within the organization

Flexibility during organizational and/or business changes

Demonstrate excellent analysis and collaboration skills

Ability to work within a team effectively and efficiently

Strong interpersonal and relationship building skills

Critical listening and thinking skills

Decision making/problem solving skill

Customer service oriented

Analytical skills

Knowledge of billing practices and budgeting

Strong organizational skills and ability to multi-task and prioritize

Must be able to work and solve problems independently by applying analytical and logical thinking

Able to organize and present basic reports and information to applicable internal parties

Able to define problems, collect data, establish facts, and draw valid conclusions

Licensure and Certification: Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver’s license record check. If the driver’s license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated

To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.

CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions: General office environment; may be required to sit or stand for extended periods of time

Up to 15% (occasional) travel based on the needs of the department may be required

$94,100.00 - $164,800.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Salary

Organization Level Competencies

- Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

#LI-JM1