Manager, Integrated Care Waiver Operations

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 Care Source 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.

• 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.

• 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

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…