[Remote] Manager, LTSS Service Determination Operations

Note: The job is a remote job and is open to candidates in USA. CareSource is a healthcare organization focused on delivering quality services to its members. The Manager, LTSS Service Determination Operations is responsible for leading operations related to long-term services and supports, ensuring compliance and member-centered decisions while collaborating with various stakeholders.ResponsibilitiesServe as the primary operational lead for LTSS service determinations within an assigned market(s), ensuring alignment with state‑specific program rules, waiver requirements, contractual obligations, and workflow nuancesAct as the key market‑level liaison for LTSS service determinations, partnering with local Care Management, Clinical, Product, and Compliance stakeholders to ensure operational readiness and issue resolutionEnsure timely and accurate determinations in alignment with medical necessity guidelines, benefit rules, and regulatory requirementsDrive consistency in service determinations across PCA, GAFC/AFC, Home Health, and Flexible BenefitsServe as the primary operational owner of the service determination workflow (interim and future-state)Provide input into process design, rollout strategy, and system enhancements, ensuring operational feasibility and scalabilityIdentify gaps, inefficiencies, and variation in decision-making and implement standardized solutionsLead continuous improvement initiatives focused on quality, turnaround time, and member experienceDevelop and execute training and onboarding programs for new and existing staffEnsure team readiness for new workflows, regulatory updates, and system changesPartner with CM, Clinical and Compliance teams to ensure staff are trained on medical necessity guidelines and LTSS program distinctionsDirectly manage and develop a team of service determination professionalsProvide coaching, mentorship, and performance management to drive high-quality outcomesMonitor key performance indicatorsIdentify and mitigate risks related to service misalignment, duplication of services, and documentation gapsPerform any other job related duties as requestedSkillsBachelor's degree requiredEquivalent years of relevant work experience may be accepted in lieu of required educationThree (3) years of experience in healthcare operations, with a strong focus on LTSS and Medicaid requiredTwo (2) years of leadership experience managing teams in a healthcare or managed care environment requiredUnderstanding of LTSS programs, including PCA (Personal Care Attendant), GAFC/AFC, Home Health Services, and Home and Community Based ServicesProficient with Microsoft Office to include Word, Excel, and PowerPointExcellent written and verbal communications skillsAbility to develop, prioritize and accomplish goalsDetail orientedStrong interpersonal skills and high level of professionalismEffective listening and critical thinking skillsEffective problem-solving skills with attention to detailAbility to work independently and within a teamStrong negotiation skillsExcellent leadership skillsAbility to create and maintain excellent working relationshipsThree (3) years of experience supporting process redesign, transformation, or system implementation preferredExperience with assessment tools (MDS, functional assessments, health risk assessments) preferredBenefitsIn addition to base compensation, you may qualify for a bonus tied to company and individual performance.We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.Company OverviewCareSource provides managed care services to Medicaid beneficiaries. It was founded in 1989, and is headquartered in Dayton, Ohio, USA, with a workforce of 1001-5000 employees. Its website is https://www.caresource.com/.