Operations Manager Medicaid Health Home

Responsibilities

The Operations Manager provides leadership for Medicaid Health Home administrative functions, internal Care Management Agency operations, and the In-Person Assistor grant program. This role translates regulatory and contractual requirements into operational plans while overseeing staff performance, quality, and financial sustainability.

Requirements

Candidates must possess a bachelor's degree and at least 5 years of management or supervisory experience. Additionally, a minimum of 2 years of experience in Health Home Care Management or Administration is required.

Skills

• Operational leadership
• Project management
• Medicaid health home administration
• Care management
• Staff supervision
• Policy making
• Data management
• Contract oversight
• Financial management
• Audit readiness
• Conflict resolution
• Capacity planning
• Performance monitoring
• Regulatory compliance
• Communication
• Resourcefulness

Benefits

• Paid time off
• Company holidays
• Vacation time
• Sick time
• Medical insurance
• Dental insurance
• Vision insurance
• Life insurance
• Disability protection
• Retirement benefits
• Employer match

About this role

The best thing about this role

Are you looking to make a difference by improving the health of our patients? Here you will find an innovative culture that is patient-focused and dedicated to making a difference. We are committed to helping the population we serve, and our communities, achieve optimum health and enjoy the best quality of life possible.

What you'll do

The Operations Manager provides operational leadership and oversight for three related areas: the organization’s Medicaid Health Home administrative functions and responsibilities to the New York State Department of Health (NYSDOH); internal Care Management Agency (CMA) operations; and the In-Person Assistor (IPA) grant program, which helps individuals without health insurance access coverage. The position also oversees operational performance and partner coordination under contracts with Managed Care Organizations (MCOs) and external CMAs, within the authority assigned to the role. The Operations Manager translates organizational, regulatory, contractual, and program requirements into operational plans, workflows, performance expectations, and continuous improvement activities.
The role oversees day-to-day functioning and performance across these areas, including workforce and capacity planning, enrollment and outreach operations, documentation and reporting processes, billing and reimbursement performance, quality and audit readiness, contract deliverables and external partner performance, grant deliverables, and operational and financial sustainability. The position leads assigned supervisors and staff, coordinates with internal departments and external stakeholders, and identifies and addresses operational risks and performance gaps.
Health Home Administration and NYSDOH Program Operations
Oversee the operational administration of the Medicaid Health Home program and coordinate activities necessary to support the organization’s responsibilities to the New York State Department of Health (NYSDOH).
Maintain working knowledge of applicable federal and New York State laws, regulations, guidance, contractual requirements, and program standards relevant to assigned responsibilities.
Coordinate preparation, review, submission, and follow-up of required program reports, data, documentation, and other deliverables, in collaboration with the appropriate internal departments and program leaders.
Monitor program performance, operational requirements, and emerging issues; identify gaps and coordinate timely corrective action and escalation as appropriate.
Develop, maintain, and improve program policies, procedures, workflows, and operational controls to support consistent implementation of Health Home requirements.
Coordinate audit readiness, record reviews, requests for information, and follow-up on findings or corrective action plans within the scope of the position.
Serve as an operational point of coordination among Health Home administration, internal departments, leadership, and external stakeholders as assigned.
Support maintenance of required program designation, approvals, and operational documentation, in coordination with accountable organizational leaders.
Internal Care Management Agency (CMA) Operations
Oversee day-to-day operations of the internal CMA, including referral management, outreach, enrollment, care navigation workflows, documentation processes, and operational follow-through.
Establish and monitor operational expectations, performance measures, and workflows that support timely member engagement, enrollment, service delivery, documentation, and retention.
Oversee staffing and capacity planning, caseload distribution, workload management, and resource allocation in collaboration with supervisors and program leadership.
Provide direction and support to supervisors and assigned staff; establish expectations, delegate responsibilities, monitor performance, and address operational barriers.
Monitor enrollment, caseload, documentation, billing submission, reimbursement, outstanding billing, disenrollment, and other operational indicators; develop action plans to address performance gaps.
Coordinate with billing, finance, information technology, quality, compliance, and other departments to resolve system, documentation, eligibility, workflow, and reimbursement issues.
Support consistent implementation of required care management processes, including person-centered planning and documentation, while maintaining clear distinctions between operational oversight and the clinical or direct-service responsibilities of care management staff.
Develop and implement staff orientation, ongoing training, competency support, and process updates in collaboration with subject matter experts and relevant departments.
Monitor quality and audit findings related to CMA operations and coordinate improvement activities, staff education, and follow-up.
Evaluate opportunities to improve appropriate internal CMA enrollment, operational efficiency, member access, and financial sustainability.
In-Person Assistor (IPA) Grant Program
Oversee operational implementation of the In-Person Assistor grant program, which assists individuals who do not have health insurance with accessing and obtaining coverage.
Coordinate staffing, outreach approaches, workflows, training, and operational support necessary to deliver program services and meet approved grant expectations.
Monitor program activity, performance measures, deliverables, and reporting requirements; identify barriers and coordinate corrective actions as needed.
Coordinate with grant administrators, internal departments, community organizations, and other stakeholders to support access to insurance enrollment assistance and program effectiveness.
Monitor grant-related documentation, resource use, and fiscal or administrative requirements within the authority assigned to the position.
Ensure staff understand program expectations, applicable procedures, documentation standards, and escalat...

About Bassett Healthcare Network

Hospitals and Health Care · 1,001-5,000 employees · headquartered in Cooperstown, NY · founded 1922