Manager, LTSS Service Determination Operations

Responsibilities

• Lead day-to-day operations for market-specific LTSS service determination functions to ensure accurate and compliant service translation.
• Serve as the primary operational lead and liaison for LTSS determinations, partnering with Clinical, Product, and Compliance stakeholders.
• Ensure timely and accurate determinations in alignment with medical necessity guidelines, benefit rules, and regulatory requirements.
• Drive consistency in service determinations across PCA, GAFC/AFC, Home Health, and Flexible Benefits.
• Own the service determination workflow, providing input into process design, rollout strategy, and system enhancements.
• Identify inefficiencies and implement standardized solutions to improve quality and turnaround time.
• Directly manage, coach, and develop a team of service determination professionals.
• Monitor key performance indicators and mitigate risks related to service misalignment or documentation gaps.

Requirements

• Bachelor's degree required (equivalent relevant work experience may be accepted in lieu of education).
• Three (3) years of experience in healthcare operations, with a strong focus on LTSS and Medicaid.
• Two (2) years of leadership experience managing teams in a healthcare or managed care environment.
• Proficiency with Microsoft Office, including Word, Excel, and PowerPoint.
• Strong written and verbal communication skills.
• Excellent problem-solving, critical thinking, and interpersonal skills.

Preferred Qualifications

• Three (3) years of experience supporting process redesign, transformation, or system implementation.
• Experience with assessment tools such as MDS, functional assessments, or health risk assessments.

About the Company

CareSource is a mission-driven organization dedicated to creating a better world for members, stakeholders, and providers. We combine compassionate care with business expertise to provide consumer-centric solutions that make a meaningful difference in our communities.