Operations Manager Medicaid Health Home

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.

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 escalation processes.

Workforce and Human Resource Management Develop and recommend staffing and coverage plans that align with program demand, service expectations, available resources, and approved budgets. Participate in recruitment, interviewing, onboarding, orientation, retention, and workforce development activities for assigned personnel. Establish performance expectations, monitor staff and supervisor performance, provide feedback, and address performance or conduct concerns in accordance with organizational policy.

Delegate work and accountabilities, establish work priorities and schedules, and ensure staff have the training, tools, and information needed to perform assigned duties. Promote staff development, collaboration, accountability, and a respectful, patient-centered work environment. Contract and External Partner Oversight Oversee operational administration and monitoring of contracts and working relationships with Managed Care Organizations (MCOs) and external Care Management Agency (CMA) partners, within the authority assigned to the position.

Monitor partner performance against applicable contract requirements, service expectations, deliverables, reporting timelines, and established performance measures; identify gaps and coordinate timely follow-up. Coordinate with MCOs, external CMAs, internal Health Home and CMA teams, Finance, Compliance, Legal, and other departments to resolve operational issues involving referrals, enrollment, member assignment, documentation, billing, reporting, and care coordination workflows, as applicable.

Maintain processes for tracking contract obligations, partner performance concerns, required deliverables, outstanding action items, and issue resolution; escalate material risks, recurring deficiencies, or potential noncompliance to appropriate leadership. Coordinate routine communication and operational meetings with MCOs and external CMA partners, as appropriate, to review performance, address barriers, communicate process changes, and support consistent implementation of program requirements.

Support contract development, review, renewal, amendment, and implementation by providing operational input, identifying service and workflow requirements, and coordinating with the designated contract owner and responsible organizational departments. Coordinate partner performance reviews and corrective action follow-through when needed, in collaboration with the appropriate internal leaders and contract owners. Financial and Resource Management Monitor operational and financial performance for assigned program areas in collaboration with Finance and program leadership.

Review available financial and operational data to identify trends, risks, opportunities, and actions to improve efficiency and sustainability. Assist in developing, monitoring, and managing operational budgets, staffing plans, and resource projections within delegated authority. Coordinate with Finance, billing, procurement, vendors, and other departments on operational matters, as assigned.

Identify opportunities to improve appropriate revenue capture, enrollment and billing workflows, resource utilization, and cost effectiveness. Monitor grant-related resources and deliverables in accordance with approved grant requirements and organizational processes. Quality, Compliance, and Continuous Improvement Promote consistent application of approved policies, procedures, and program standards across assigned areas.

Use operational data, audits, staff feedback, and stakeholder input to identify process deficiencies and opportunities for improvement. Develop, implement, and monitor corrective action plans and process improvements within the scope of the position. Coordinate with Quality, Compliance, Legal, Finance, Information Technology, and other subject matter experts when issues require specialized review or decision-making.

Ensure potential regulatory, operational, financial, privacy, or service-delivery risks are escalated to the appropriate leadership in a timely manner. Communication, Collaboration, and Leadership Provide timely and accurate updates to leadership on program performance, risks, barriers, staffing, financial matters, and improvement initiatives. Communicate operational changes, requirements, and expectations to staff and relevant stakeholders.

Represent assigned program areas in internal meetings and external forums, as delegated. Build effective working relationships across departments, affiliates, community partners, and other stakeholders to resolve issues and support program objectives. Perform other related duties as requested or directed.

What we need from you

4 Year/Bachelor's Degree, required. Experience may be considered in lieu of education

Minimum 5 years management/supervisory experience, required Minimum 2 years of Health Home Care Management/Administration experience, required Licensure/Certifications: NYS Driver's License, required

Analysis & Evaluation Project Management/Planning Leadership Coaching Conflict Resolution Policy Making Data Management Computer Skills Resourcefulness Communication Manage People Organizing/Categorizing records Multi-Tasking Time Management Physical

Sedentary Work - Exerting up to 10 lbs of force occasionally, and/or a negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking or standing are required only occasionally, and all other sedentary criteria are met Occasional balancing, climbing, crouching, grasping, kneeling, lifting, pulling, pushing, reaching, repetitive motion, standing, stooping, visual acuity (color, depth, perception), walking Frequent hearing, talking Constant typing/clerical/dexterity, seeing/monitor/computer us Travel: Occasional Travel - The job may require travel from time- to-time, but not on a regular basis Total Rewards Bassett Healthcare Network’s commitment to our employees includes benefit programs carefully designed with the needs and values of all our employees in mind.

Many of the benefits we offer are paid fully or in large part by Bassett. Our generous benefits offerings include: Paid time off, including company holidays, vacation, and sick time Medical, dental and vision insurance Life insurance and disability protection Retirement benefits including an employer match And more! Specific benefit offerings may vary by location and/or position.

Salary is based on a variety of factors, including, but not limited to, qualifications, experience, education, licenses, specialty, training, and fair market evaluation based on industry standards. The above compensation range represents a good faith belief of the compensation range by Bassett Healthcare Network, and its entities and affiliates, at the time of this posting or advertisement.

Minimum: USD $76,452.30/Yr.

Maximum: USD $114,678.44/Yr. We love the difference people bring We provide equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex (including pregnancy, childbirth, or related condition), age, national origin or ancestry, citizenship, disability, marital status, sexual orientation, gender identity or expression (including transgender status), genetic predisposition or carrier status, military or veteran status, familial status, status as a victim of domestic violence, or any other status protected by law.