Sr Manager Medicaid Programs - Long Term Care

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

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for leading and managing the development, implementation, strategic day-to-day administration of managed care operations across business functions (Utilization Management, Quality Management, Project Oversight, Claims, Care Coordination) related to Long Term Care Services and Supports (LTSS). Establish and lead teams in the execution of providing operational support to include oversight, processes, procedures and direction for managed care LTSS requirements, including the Electronic Visit Verification system, LTSS audit activities and assistance with FIDE implementation initiatives. Serve as champion of operations to ensure that operations teams enhance the effectiveness, quality and LTSS objectives of the Medicaid program. This position will assist in the development (along with business leaders and clinical leadership) of processes that ensure operations are compliant with internal and external requirements, including federal and state Medicaid regulations.

JOB REQUIREMENTS:

• Bachelors degree in Business or Health Care.
• 3 years in a leadership/management position to include experience managing diverse groups, multiple priorities/activities effectively and independently
• 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 to include interaction with all levels of management and/or external customers
• 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.

PREFERRED JOB REQUIREMENTS:

• Medicaid Long-Term Care program experience strongly preferred.

This is a Flex (Hybrid) role: 3 days in the office; 2 days remote.

Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!

Pay Transparency Statement:

At Health Care Service Corporation, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From 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, we offer a robust total rewards package for employees. Learn more about our benefit offerings by visiting https://careers.hcsc.com/totalrewards.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

HCSC Employment Statement:

We are an Equal Opportunity Employment employer dedicated to providing a welcoming environment where the unique differences of our employees are respected and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

Base Pay Range

$92,700.00 - $167,500.00

Exact compensation may vary based on skills, experience, and location.