Medicaid LTSS Operations Lead

Health Care Service Corp.; Albuquerque (NM); Hybrid; USD 93,000 - 168,000; Full time

Benefits offered by this job

Health and wellness benefits

401(k) savings plan

Pension plan

Paid time off

Paid parental leave

Disability insurance

Supplemental life insurance

Employee assistance program

Paid holidays

Tuition reimbursement

Plus other incentives

Job summary

Health Care Service Corporation (HCSC) seeks a senior operations leader to oversee LTSS managed care across Utilization Management, Quality, Claims and Care Coordination in a hybrid role (3 days in office, 2 remote). You will drive process design, compliance with Medicaid regs, and LTSS objectives with cross-functional teams.

The role requires a Bachelor's in Business or Health Care, 7+ years in health care, and proven leadership, budgeting, negotiation and contract interpretation skills to

Qualifications

• Bachelor's degree in Business or Health Care.
• 3 years in a leadership/management position.
• 7 years health care experience and knowledge of contract interpretation.
• Knowledge of contract provisions relating to home health agencies, nursing facilities, and other Medicaid providers.
• Budgeting/accounting experience.
• Verbal, written communication and presentation skills.
• Analytical, critical thinking, planning, time management, and organizational skills.
• Negotiation skills to request additional revenue, changes to contract parameters and new business.
• PC proficiency to include Word, Excel, PowerPoint, and email.
• Some travel required.

Responsibilities

• Lead and manage development, implementation, and day-to-day administration of LTSS managed care operations across business functions.
• Establish and lead teams for oversight of LTSS requirements, including EVV, LTSS audits and FIDE initiatives.
• Ensure operations align with Medicaid regulations and internal/external requirements.
• Collaborate with business and clinical leadership to develop compliant processes.

Skills

Leadership/management

Contract interpretation

Budgeting/Accounting

Verbal/written communication

Analytical thinking

Negotiation

PC proficiency (Word/Excel/PowerPoint)

Travel

Education

Bachelor's degree in Business or Health Care

Job description

Health Care Service Corporation (HCSC) seeks a senior operations leader to oversee LTSS managed care across Utilization Management, Quality, Claims and Care Coordination in a hybrid role (3 days in office, 2 remote). You will drive process design, compliance with Medicaid regs, and LTSS objectives with cross-functional teams.

The role requires a Bachelor's in Business or Health Care, 7+ years in health care, and proven leadership, budgeting, negotiation and contract interpretation skills to