Operations Manager - CME

Job Description

Summary/Objective

The Operations Manager oversees outreach and intake operations within the CME and ensures that all procedures, processes, and compliance standards are met. This role is responsible for supervising outreach staff, monitoring care coordination guidelines, referrals, and documentation, and ensuring timely action on member needs. The Operations Manager collaborates with Care Coordination Managers, Clinical Supervisors, and Health Data staff to ensure seamless service delivery.

In addition to compliance oversight, this position is expected to identify gaps, develop innovative solutions, and implement new processes to strengthen operations across the CME. The Operations Manager works closely with finance and billing to ensure documentation accuracy, while also supporting community partnerships and system-level coordination.

Essential Functions

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Supervise outreach and intake staff to ensure compliance with care coordination guidelines under the Aetna contract.

Monitor referrals, engagement, documentation, and contact requirements to ensure timely and accurate follow-through.

Ensure program coordinators schedule initial CANS within required timeframes.

Support the clinical escalation team and assist in workgroups related to suicide prevention, boundary training, and organizational skills for new hires.

Provide backup support when emergency CANS must be completed.

Serve as liaison to Aetna and support Care Coordinator Managers with contract compliance.

Represent the CME in meetings with courts, community partners, and stakeholders; communicate updates to program and care coordination teams.

Collaborate with finance to ensure accurate billing documentation for coordinators.

Assist the CME Director and Health Data Manager with reporting, fiscal oversight, and budgetary responsibilities.

Monitor and complete all documentation for ODM and Aetna such as IMS forms, Family Care Central, Monday.com requests, Dialpad requests, MATs system access requests and equipment requests for I Am Boundless IT.

Monitoring and storing credentialing documents, and COE certificates.

Review and approve all Emburse reimbursements

Proactively identify process gaps and implement improvements to enhance service delivery and organizational efficiency

Perform additional duties as assigned by the CME Director.

Other Responsibilities

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties, or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Supervisory Duties

This position directly supervises the Outreach Supervisor and provides support to the supervision of outreach and intake staff.

Education, Skills, Experience and Requirements

Bachelor’s degree in psychology, social work, or related field with three (3) years of relevant experience.

Master’s degree preferred in psychology, social work, or related field.

Minimum of three (3) years of experience in children’s behavioral health, child welfare, developmental disabilities, juvenile justice, or a related human services field.

Experience providing community-based services to children, youth, and families/caregivers.

Expertise in at least one of the following areas:

Family systems

Community systems and resources

Case management

Child and family counseling or therapy

Child protection

Child development

Strong leadership and problem-solving skills; ability to think strategically and implement solutions.

Excellent communication skills (oral and written) with high professional standards.

Exceptional organizational skills with the ability to prioritize tasks and meet deadlines.

Ability to collaborate across departments and serve as a representative of the organization in the community.

Knowledge of care coordination systems, reporting, and compliance standards.

Intermediate computer skills and ability to learn new software and reporting systems.

Professionalism and tact when working with staff, partners, members, and families.

Valid Ohio Driver’s License with proof of insurance and an insurable driving record (five points or fewer).

Licensure/Certification

Ability to obtain and maintain First Aid and CPR certification (adult, child, and infant).

Current High-Fidelity Wraparound and CANS Assessor training (or ability to complete within 90 days of hire).

Training in cultural competency (or ability to complete within 90 days of hire).

Competencies and Attributes

Expertise in quality improvement methodologies and tools.

Proficiency in data analytics and dashboard tools.

Strong project management and team leadership abilities.

Proven ability to manage remote teams effectively.

Exceptional communication and stakeholder engagement abilities.

Ability to build cross-functional collaboration and alignment.

Ethical conduct and integrity.

Detail-oriented and flexible.

Team-oriented and composed under pressure.

Physical Demands/% of time

Lifting and/or carrying up to 15lbs

<25%

Hearing

>75%

Sitting

>75%

Near visual acuity

>75%

Use of electronics (i.e. computer, tablet)

>75%

Manual dexterity

>75%

Use of office equipment (i.e. copier/scanner)

>75%

Standing and/or walking

25-5-%

Verbal communication

>75%

Work Hours: This is a full-time position, typically Monday through Friday, 8:30 a.m. to 5:00 p.m., with occasional evening or weekend work as needed.

Travel Requirements: Primarily local travel during business hours, with occasional out-of-area or overnight travel for conferences, meetings, or audits.

Full-time