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.

#LI-LO1

#LI-Hybrid

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 .

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.

Base Pay Range
$92,700.00 - $167,500.00

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