Supervisor Medicare Long Term Services & Support Operations

Responsibilities

• Ensures and improves the performance, productivity and efficiency of Medicare LTSS Care Coordination Operations.
• Provides operational oversight and process improvement supporting Medicare LTSS Operations including clinical direction and monitoring of Medicare LTSS case management services.
• Ensures effective daily operation of the Medicare LTSS Care Coordination team complying with all applicable statutory provisions, contracts and established policies and administrative procedures.
• Supervises staff, delegates tasks and accountabilities.
• Maintains optimal staffing patterns based on current departmental budget.
• Complies with all Human Resources Policies and Procedures for personnel requisitions, interviewing and being knowledgeable in and compliant with all plan policies and procedures relating to employee performance review, attendance, counseling and corrective action.
• Participates in and coordinates training and education of new and existing staff.
• Develops and maintains policies and procedures, workflows and desk level procedures as needed.
• Actively pursues strategic and operational objectives relative to performance optimization.
• Assists in the development of strategic plans for operational activity.
• Proactively works with stakeholders to develop business strategy, expansion of solutions and facilitate business renewal.
• Improves processes and policies in support of organizational goals.
• PARTNER WITH CROSS-FUNCTIONAL SUPPORT TEAMS TO IMPLEMENT PROCESS IMPROVEMENT.
• IDENTIFIES OPPORTUNITIES FOR PROGRAM PERFORMANCE IMPROVEMENT AND CONtributes TO THE DEVELOPMENT OF INITIATIVES RELATED TO COMPLIANCE, PERFORMANCE AND PROGRAM EXPANSION.
• GROW THE EFFICIENCY OF THE EXISTING ORGANIZATIONAL PROCESSES AND PROCEDURES TO SUPPORT THE QUALITY AND COMPLIANCE OF OPERATIONS FOR MEDICARE LTSS CARE COORDINATION, INCLUDING REGULATORY PERFORMANCE.
• ENSURES THAT OPERATION OBJECTIVES ARE CREATED, ON TRACK AND SUBMITS INTERIM REPORTS AS REQUESTED BY STAKEHOLDERS.
• WORKS COLLABORATIVELY WITH MEDICARE QUALITY ASSURANCE, MEDICARE IS AND MEDICAL INFORMATICS DEPARTMENTS, WITH A DOTTED LINE RELATIONSHIP TO MEDICARE CHIEF MEDICAL OFFICER.
• Maintains a current knowledge of CMS and DHHS requirements.
• Adheres to AmeriHealth Caritas policies and procedures.
• CREATES AND SUPPORTS AN ENVIRONMENT WITH FOSTERS TEAMWORK, COOPERATION, RESPECT AND DIVERSITY.
• INSTILLS WORK CULTURE OF CONTINUOUS PROCESS IMPROVEMENT, INNOVATION AND QUALITY.
• DEMONSTRATES AND SUPPORTS COMMITMENT TO CORPORATE GOALS AND OBJECTIVES.

Qualifications

• Licensed Clinical Social Worker (LCSW), Licensed Master Social Worker (LMSW), or Registered Nurse (RN).
• 1 to 3 years Supervision of remote team experience.
• 3 to 5 years LTSS Case Management experience.
• Proficient PC skills with Microsoft Office Suite (Word, Excel, etc.).
• Strong knowledge of Medicare/MMP/HIDE LTSS.
• Excellent problem solving and organization skills.
• Ability to work independently or as a team.
• Strong interpersonal communication skills.
• Ability to maintain positive relationships with both internal and external customers.
• Process Oriented.
• Attention to detail.
• Effective time management.
• Pro-active with ability to multi-task.
• The ability to consistently identify mistakes.
• The ability to closely follow quality standards.
• Decision making skills.
• Demonstrated experience developing and maintaining documentation, including participation in policy and procedure creation.

Benefits

• Flexible work solutions including remote options, hybrid work schedules.
• Competitive pay.
• Paid time off including holidays and volunteer events.
• Health insurance coverage for you and your dependents on Day 1.
• 401(k).
• Tuition reimbursement.
• and more.