Medicaid LTSS Operations Leader (Hybrid)

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

Job summary

Health Care Service Corporation (HCSC) seeks a Senior Manager to lead and manage development, implementation, and day-to-day administration of LTSS managed care operations across Utilization Management, Quality Management, project oversight, claims, and care coordination.

The role drives cross-functional collaboration, ensures compliance with federal and state Medicaid regulations, and oversees LTSS processes and the E Visit Verification system. Travel required; hybrid schedule.

Qualifications

• Bachelor's degree in Business or Health Care.
• 3 years in a leadership/management position to lead diverse groups.
• 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.
• Strong verbal, written communication and presentation skills.
• Analytical, planning, time management and organizational skills.
• Negotiation skills to request revenue changes and new business.
• PC proficiency including Word, Excel, PowerPoint, and email.
• Some travel required.

Responsibilities

• Lead and manage development, implementation, and day-to-day administration of LTSS managed care operations.
• Oversee utilization management, quality management, project oversight, claims and care coordination for LTSS.
• Ensure compliance with federal/state Medicaid regulations and LTSS requirements.
• Collaborate with business leaders and clinical leadership to develop compliant processes.

Skills

Leadership

Health care experience

Contract interpretation

Budgeting

Communication

Analytical thinking

Time management

Negotiation

PC proficiency

Travel

Education

Bachelor's degree in Business or Health Care

Tools

Word

Excel

PowerPoint

Job description

Health Care Service Corporation (HCSC) seeks a Senior Manager to lead and manage development, implementation, and day-to-day administration of LTSS managed care operations across Utilization Management, Quality Management, project oversight, claims, and care coordination.

The role drives cross-functional collaboration, ensures compliance with federal and state Medicaid regulations, and oversees LTSS processes and the E Visit Verification system. Travel required; hybrid schedule.