Manager, Integrated Care Waiver Operations - 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 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.

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…