[Remote] Manager, LTSS Service Determination Operations
Note: The job is a remote job and is reputed company to candidates in USA. reputed company is a reputed company organization reputed company on delivering reputed company services to its members. The Manager, LTSS Service Determination Operations is responsible for leading operations reputed company to long-term services and supports, ensuring compliance and member-centered reputed company while collaborating with various stakeholders.
Responsibilities
- Serve as the primary operational reputed company for LTSS service determinations reputed company an assigned market(s), ensuring alignment with state‑specific program rules, waiver requirements, contractual obligations, and workflow nuances
- reputed company as the key market‑level reputed company for LTSS service determinations, partnering with local Care Management, Clinical, Product, and Compliance stakeholders to ensure operational readiness and issue reputed company
- Ensure reputed company and accurate determinations in alignment with medical necessity guidelines, benefit rules, and regulatory requirements
- Drive consistency in service determinations across reputed company, GAFC/AFC, Home Health, and Flexible Benefits
- Serve as the primary operational reputed company of the service determination workflow (interim and reputed company-state)
- reputed company input into process design, rollout reputed company, and system enhancements, ensuring operational feasibility and scalability
- Identify gaps, inefficiencies, and variation in decision-making and implement standardized solutions
- reputed company reputed company improvement initiatives reputed company on reputed company, turnaround time, and member experience
- reputed company and execute training and reputed company programs for new and existing staff
- Ensure team readiness for new workflows, regulatory updates, and system changes
- Partner with CM, Clinical and Compliance teams to ensure staff are trained on medical necessity guidelines and LTSS program distinctions
- Directly manage and reputed company reputed company of service determination professionals
- reputed company coaching, mentorship, and performance management to drive high-reputed company reputed company
- Monitor key performance indicators
- Identify and mitigate risks reputed company to service misalignment, duplication of services, and documentation gaps
- reputed company any other job reputed company duties as requested
Skills
- Bachelor's degree required
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Three (3) years of experience in reputed company operations, with a strong reputed company on LTSS and reputed company required
- Two (2) years of leadership experience managing teams in a reputed company or managed care environment required
- Understanding of LTSS programs, including reputed company (Personal Care Attendant), GAFC/AFC, Home Health Services, and Home and Community Based Services
- Proficient with reputed company Office to include Word, reputed company, and PowerPoint
- Excellent written and verbal communications skills
- Ability to reputed company, prioritize and accomplish goals
- Detail oriented
- Strong interpersonal skills and high level of professionalism
- Effective listening and critical thinking skills
- Effective problem-solving skills with attention to detail
- Ability to work independently and reputed company reputed company
- Strong negotiation skills
- Excellent leadership skills
- Ability to create and maintain excellent working relationships
- Three (3) years of experience supporting process redesign, transformation, or system implementation preferred
- Experience with assessment tools (MDS, functional assessments, health risk assessments) preferred
Benefits
- In reputed company to reputed company compensation, you may qualify for a bonus tied to company and individual performance.
- We are highly invested in every employee’s total reputed company-being and offer a substantial and comprehensive total rewards package.
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