Manager, Integrated Care Waiver Operations - Must Live in Ohio

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

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 yearlyOversight for Medicare and Medicaid audit preparation and presentationResponsible to development and implementation of action plans related to regulatory feedback on reporting and/or audits, including for delegated vendorsActively 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 requirementsGenerate and develop monthly reporting and recommendations based on findings from monitoring activitiesConduct monthly and/or quarterly quality reviews with the Operations and Case Management teamWork cross-functionally with care coordination team to identify process gaps and drive improvementsAnalyze and report financial savings related to process improvementsReport financial cost related to outages and process issuesCompile reports and departmental communicationsParticipate in strategic planning and implement action plansBuild 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 improvementsReview documentation gathered by internal staff and external partners to ensure thoroughness, accuracy and care management competencyContribute to the ongoing development of processes and support of care coordination care plans, defining specific issues, goals and interventions as appropriateWorking 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 complianceDevelop tools to provide effective care planning and implementation meeting member needsOversee 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 careProvides updates to Incident Management program to support the investigation process related to member health and safetyDevelop and monitor scheduling/work allocation and productivityWork with corporate staff in the follow up and review of member complaints and grievancesMonitor and analyze Integrated Care Management data and reportingAssure overall compliance with the program descriptions/models of care for all Integrated Care lines of businessPerform any other job related duties as requested.Education and Experience:Bachelor's degree in Business Administration, Health Care or other related field requiredTwo (2) years of health care experience requiredExperience in HCBS programs preferredPrevious management experience requiredManaged care, Medicaid Billing and/or JFS Program experience preferredCompetencies, Knowledge and Skills:Intermediate to Advanced Microsoft Office skills: Word and ExcelExceptional written and verbal communication skillsAbility to gather work related information and coordinate workflow and assist programs teamsAbility to work with a variety of disciplines and levels of staff across departmentsProven ability to effectively interact with all levels of management within the organizationFlexibility during organizational and/or business changesDemonstrate excellent analysis and collaboration skillsAbility to work within a team effectively and efficientlyStrong interpersonal and relationship building skillsCritical listening and thinking skillsDecision making/problem solving skillCustomer service orientedAnalytical skillsKnowledge of billing practices and budgetingStrong organizational skills and ability to multi-task and prioritizeMust be able to work and solve problems independently by applying analytical and logical thinkingAble to organize and present basic reports and information to applicable internal partiesAble to define problems, collect data, establish facts, and draw valid conclusionsLicensure 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 terminatedTo 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:General office environment; may be required to sit or stand for extended periods of timeUp to 15% (occasional) travel based on the needs of the department may be requiredCompensation Range:$94,100.00 - $164,800.00CareSource 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 (hourly/salary):SalaryOrganization Level CompetenciesFostering a Collaborative Workplace CultureCultivate PartnershipsDevelop Self and OthersDrive ExecutionInfluence OthersPursue Personal ExcellenceUnderstand the BusinessThis job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.#LI-JM1Brand=CareSource