LTSS Service Determination Leader - Operations & Impact

CareSource; Mobile (AL); On-site; USD 75,000 - 120,000; Full time

Job summary

CareSource is seeking a Manager of LTSS Service Determination Operations to lead day-to-day market-specific LTSS determinations. You will ensure accurate, timely decisions, align with medical necessity guidelines and regulatory requirements, and drive cross-functional collaboration with CM, Clinical, Product, and Compliance teams.

The role requires a Bachelor's degree, 3 years in healthcare operations focused on LTSS/Medicaid, and 2 years of leadership experience in a healthcare environment.

Qualifications

• Bachelor's degree required.
• Three (3) years of experience in healthcare operations with LTSS/Medicaid.
• Two (2) years of leadership experience managing teams in healthcare/managed care.
• Three (3) years of experience supporting process redesign, transformation, or system implementation preferred.
• Experience with assessment tools (MDS, functional assessments, health risk assessments) preferred.

Responsibilities

• Lead LTSS service determinations for assigned markets and align with state rules, waivers, contracts, and workflows.
• Collaborate with Care Management, Clinical, Product, and Compliance stakeholders to ensure readiness and issue resolution.
• Ensure timely, accurate determinations in line with medical necessity, benefits, and regulatory requirements.
• Drive consistency of service determinations across PCA, GAFC/AFC, Home Health, and Flexible Benefits.
• Develop and own the service determination workflow; guide design, rollout, and system enhancements.
• Provide training and onboarding for staff; monitor readiness for updates and changes.
• Mentor and manage a team of service determination professionals; drive performance.
• Monitor KPIs and identify risks; implement standardized improvements.

Skills

Leadership

Healthcare operations

LTSS knowledge

Regulatory compliance

Project management

Communication

Analytical thinking

Education

Bachelor's degree

Tools

MDS tools

Assessment tools

Job description

CareSource is seeking a Manager of LTSS Service Determination Operations to lead day-to-day market-specific LTSS determinations. You will ensure accurate, timely decisions, align with medical necessity guidelines and regulatory requirements, and drive cross-functional collaboration with CM, Clinical, Product, and Compliance teams.

The role requires a Bachelor's degree, 3 years in healthcare operations focused on LTSS/Medicaid, and 2 years of leadership experience in a healthcare environment.