Sr Manager Medicaid Programs - Long Term Care

Medicaid; Albuquerque (NM); Hybrid; USD 93,000 - 168,000; Full time

Job summary

HCSC is seeking a Senior LTSS Operations Leader to guide the development and day-to-day administration of managed care LTSS across Utilization Management, Quality Management, and Claims.

You will build and lead teams, establish processes and ensure compliance with federal and state Medicaid requirements, including EVV and LTSS audits, while collaborating with business and clinical leaders to drive LTSS objectives.

Qualifications

• Bachelors degree in Business or Health Care.
• 3 years in a leadership/management position.
• 7 years health care experience and contract interpretation.
• Knowledge of contract provisions for Medicaid providers.
• Budgeting/accounting experience.
• Verbal, written communication and presentation skills.
• Analytical, planning and time management skills.
• Negotiation to request revenue or changes to contracts.
• PC proficiency: Word, Excel, PowerPoint, email.
• Some travel required.

Responsibilities

• Lead and manage LTSS operations across business functions.
• Oversee processes, procedures and direction for LTSS requirements.
• Champion operations to enhance effectiveness and LTSS objectives.
• Support development of compliant processes with internal/external regs.

Skills

Leadership

Budgeting

Communication

Analytical thinking

Negotiation

MS Office

Travel

Education

Bachelor's degree

Tools

Word

Excel

PowerPoint

Email

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.

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.

Compensation: $92,700.00 - $167,500.00

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

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.

To learn more about available benefits, please click https://careers.hcsc.com/totalrewards