Manager, Integrated Care Waiver Operations

CareSource; Ohio; On-site; USD 94,000 - 165,000; Full time

Job summary

CareSource seeks a Manager, Integrated Care Waiver Operations to lead regulatory reporting, audits, and compliance for Medicare and Medicaid programs. You will oversee Care Management operations, drive quality outcomes and process improvements through data analysis and cross-functional collaboration.

The role focuses on ensuring adherence to state and federal requirements, developing action plans, and guiding staff toward efficient, compliant service delivery.

Qualifications

• Bachelor's degree required in relevant field
• Two years of health care experience required
• Experience with HCBS programs preferred
• Previous management experience required

Responsibilities

• Lead CMS, ODM and regulatory reporting on a monthly, quarterly and yearly basis
• Develop and implement action plans from regulatory feedback
• Oversee Care Management operations ensuring quality outcomes and compliance
• Conduct monthly/quarterly quality reviews with Operations and Case Management
• Collaborate across departments to drive process improvements

Skills

Leadership

Regulatory reporting

Data analysis

Project management

Communication

Healthcare knowledge

Audits & compliance

Cross-functional collaboration

Education

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

Two years of health care experience

Managed care, Medicaid Billing or JFS experience preferred

Tools

Excel

Word

PowerPoint

Job description

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 CareSource 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 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 organizational skills and ability to multi-task and prioritize Must be able to work and solve problems independently by applying analytical and logical thinking Able to organize and present basic reports and information to applicable internal parties Able to define problems, collect data, establish facts, and draw valid conclusions Licensure and Certification: Must have valid driver's license, vehicle and verifiable insurance. Employment in this position is conditional pending successful clearance of a driver's license record check. If the driver's license record results are unacceptable, the offer will be withdrawn or, if employee has started employment in position, employment in this position will be terminated To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 - March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified. CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions

Working Conditions: General office environment; may be required to sit or stand for extended periods of time Up to 15% (occasional) travel based on the needs of the department may be required

Compensation Range

Compensation Range: $94,100.00 - $164,800.00

Compensation

CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type

Compensation Type (hourly/salary): Salary

Organization Level Competencies

Organization Level Competencies Fostering a Collaborative Workplace Culture Cultivate Partnerships Develop Self and Others Drive Execution Influence Others Pursue Personal Excellence Understand the Business

Equal Opportunity

CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

CareSource Mission

#LI-JM1 Brand=CareSource The CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer-centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we're looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.