LTSS Service Determination Operations Manager

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

Job summary

CareSource is seeking an experienced Manager, LTSS Service Determination Operations to lead market-specific LTSS service determinations and ensure compliant translation of assessments into LTSS, aligned with regulatory and cost-of-care objectives.

The role requires collaboration with Care Management, Clinical, Product, and Compliance teams to ensure operational readiness, training, and continuous improvement in quality, turnaround time, and member experience.

Qualifications

• Bachelor's degree required; equivalent experience may be accepted.
• 3 years in healthcare operations focused on LTSS and Medicaid.
• 2 years leadership experience managing teams in healthcare.
• 3 years 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 ensure regulatory alignment.
• Collaborate with CM, Clinical and Compliance to ensure readiness and issue resolution.
• Ensure timely and accurate determinations aligned with medical necessity and benefit rules.
• Drive consistency across PCA, GAFC/AFC, Home Health, and Flexible Benefits.
• Own service determination workflow and future-state design.
• Develop training programs for staff and ensure readiness for regulatory updates.
• Monitor KPIs and mitigate risks related to misalignment and documentation gaps.
• Provide coaching and performance management to staff.

Skills

Communication

Detail orientation

Interpersonal skills

Problem solving

Independent work

Negotiation skills

Leadership

Relationship building

Education

Bachelor's degree

3 years healthcare operations experience

2 years leadership experience

3 years process redesign / system implementation

Tools

Microsoft Office

Job description

CareSource is seeking an experienced Manager, LTSS Service Determination Operations to lead market-specific LTSS service determinations and ensure compliant translation of assessments into LTSS, aligned with regulatory and cost-of-care objectives.

The role requires collaboration with Care Management, Clinical, Product, and Compliance teams to ensure operational readiness, training, and continuous improvement in quality, turnaround time, and member experience.