PACE Medicaid Manager

The PACE Medicaid Manager:

• Reviews pending application, activity reports and other performance data to measure productivity and goal achievement.
• Supervise and evaluate performance of staff.
• Establish and implement departmental policies, goals, objectives, and procedures, conferring with board members, organization officials, and staff members as necessary.
• Responds to telephone, written, and in-person inquiries and initiates steps to assist regarding issues relating to content or interpretation of Florida Medicaid Program.
• Supports access to care through evaluation and processing of reports, and education of staff.
• Research and resolve complex customer and business issues with Medicaid, including enrolling and recertification.
• Assists in the orientation, training, and development of new staff, volunteers and contract/consultants within department.
• Provides superior quality outcomes by taking ownership of issues to ensure timely resolution or follow-up.
• Organizes daily work without significant guidance. Provides superior, professional, and courteous service to potential enrollers and participants, including but not limited to research enrollee inquiries.
• Provides leadership in the development and implementation of the outreach programs and work plans.
• Represents department with key internal and external stakeholders and targeted providers and community partners.
• Be able to seek out Process Improvement ways to execute and improve total days from application to enrollment.
• Responsible for analyzing and addressing challenges and breakdowns in the Medicaid process.
• Perform ongoing trend analysis of Medicaid rejections and denials.
• Creates and develops reports to address management needs; analyzes information to identify trends or issues.
• Facilitating eligibility determination for Medicaid by planning and implementing a Medicaid information program.
• Other duties as assigned to support the success and evolution of the PACE model and Full Life Care's mission.

Qualifications and Requirements:

• Bachelor's degree (B.A.) from four-year college or university in accounting or a business-related field with significant accounting course work or a major in accounting or health care administration; or equivalent combination of education and experience.

Skills and Competencies:

• Strong knowledge of Medicare/Medicaid regulations, risk-based payment models, and managed care principles, and the projection of enrollments for upcoming months.
• Must possess experience communicating with government case workers and/or clinical personnel to reduce time in approval process both internally and externally.
• Strong budget development, financial management, and data-driven decision-making skills.
• Deep understanding of geriatric care, home- and community-based services, and the interdisciplinary care model
• Exceptional interpersonal, communication, and stakeholder engagement capabilities.
• Excellent organizational skills with an ability to perform in a fast-paced, deadline-oriented work environment.
• Proven ability to lead through change, resolve conflict, and build consensus across diverse teams.
• Computer proficiency, as well as the ability to develop and present presentation materials, as well as spreadsheets.
• High degree of professional accountability and ethical leadership.

Empath Health values diversity as it strengthens our community and care. We embrace the diversity of cultures, thoughts, beliefs and traditions of our employees, volunteers and people we are honored to serve across our network. Our diverse staff reflects our community and each day, we work to be respectful, sensitive and competent with each other and those in our care. In every journey, we are dedicated to achieving comfort, dignity and exceptional care. Those of all backgrounds are welcome and encouraged to apply with us or seek our care and services.

Our commitment to patient, client, staff and volunteer safety is a cornerstone of a High Reliability Organization with a focus on zero harm. Participation in the seasonal influenza is a condition of employment and a requirement for all Empath Health employees.

Providing compassionate, full life care is an honor we take seriously at Empath Health. Join our team and make a positive impact in the community!