Manager, LTSS Service Determination Operations

Lead day-to-day LTSS service determination operations for a market, ensuring accurate, timely, compliant decisions aligned with medical necessity guidelines and regulatory requirements. Act as market liaison with Care Management, Clinical, Product, and Compliance to ensure operational readiness and issue resolution, drive consistency across PCA, GAFC/AFC, Home Health, and Flexible Benefits, and own the service determination workflow. Identify gaps, drive process redesign and standardization, monitor KPIs, and oversee training and onboarding for staff; provide coaching and performance management; travel not typically required; proficient in Microsoft Office and skilled in communication, collaboration, and risk mitigation. This role requires leadership experience in healthcare operations with a focus on LTSS and Medicaid and a Bachelor's degree.