Integrated Care Operations & Compliance Lead

CareSource; Mobile (AL); On-site; USD 94,000 - 165,000; Full time

Job summary

CareSource is seeking a Manager, Integrated Care Waiver Operations to lead regulatory reporting, audits, and care management processes in Mobile, AL. You will ensure compliance with CMS, ODM, and accreditation standards while driving performance improvements and cost savings.

Leads cross-functional teams, develops action plans from regulatory findings, and partners with IT, Credentialing, and Provider Relations to optimize care delivery and member outcomes.

Qualifications

• Bachelor's degree in Business Administration, Health Care or related field required.
• 2 years of health care experience required.
• Experience with HCBS programs preferred.
• Managed care, Medicaid Billing and/or JFS Program experience preferred.

Responsibilities

• Provide leadership for CMS, ODM and regulatory reporting on a monthly, quarterly, and yearly basis.
• Oversee Medicare and Medicaid audit preparation and presentation.
• Develop and implement action plans based on regulatory feedback and audits.
• Manage Care Management operations, quality performance, and process improvements.
• Generate monthly reports and recommendations from monitoring activities.
• Conduct quality reviews with Operations and Case Management teams.
• Collaborate with care coordination to identify process gaps and drive improvements.
• Analyze and report financial savings from process improvements.
• Monitor costs related to outages and process issues.
• Coordinate with IT, Provider Relations, Credentialing, and other partners.
• Develop tools for effective care planning and implementation.

Skills

Microsoft Office

Data analysis

Regulatory compliance

Cross-functional collaboration

Communication skills

Problem solving

Education

Bachelor's degree in Business Administration, Health Care or other related field

Tools

Excel

Word

Job description

CareSource is seeking a Manager, Integrated Care Waiver Operations to lead regulatory reporting, audits, and care management processes in Mobile, AL. You will ensure compliance with CMS, ODM, and accreditation standards while driving performance improvements and cost savings.

Leads cross-functional teams, develops action plans from regulatory findings, and partners with IT, Credentialing, and Provider Relations to optimize care delivery and member outcomes.