Health Home Senior Operations Specialist Department:

Health Home Care Management Reports To:

Director of Care Management Services/Assistant Director of Care Management Services Position Summary The Health Home Clinical Operations Operations specialist is responsible for overseeing specialized clinical and operational functions that support quality care coordination, Medicaid compliance, and continuity of care for Health Home members. This position serves as the agency lead for HARP assessments and CORE referrals, Transitions of Care (TOC), Managed Care Organization (MCO) communications, and Long-Term Excluded Setting (LTES) management. The operations specialist works collaboratively with Care Managers, hospitals, behavioral health providers, Managed Care Organizations, and community partners to ensure timely completion of required activities while maintaining compliance with New York State Department of Health Health Home standards. This position serves as a clinical and operational resource to the Care Management team and supports agency quality improvement initiatives through monitoring, education, and process development. HARP Oversight

• Complete HARP Eligibility Assessments and conduct

HARP/CORE

conversations with eligible Health Home members.

• Complete Brief Eligibility Assessments (BEAs) as needed to determine HARP eligibility.
• Educate members regarding HARP services, enhanced behavioral health benefits, and available community resources.
• Coordinate referrals for CORE (Community Oriented Recovery and Empowerment) Services when clinically appropriate and ensure all required documentation is completed.
• Collaborate with Care Managers and CORE providers to support timely referrals, engagement, and continuity of care.
• Ensure all HARP-, BEA-, and CORE-related documentation is completed accurately and within New York State and Managed Care Organization (MCO) requirements.
• Monitor HARP assessment status and CORE referrals to ensure timely completion of required activities.
• Maintain compliance with all New York State Health Home, HARP, and CORE program requirements. Transitions of Care Oversight
• Manage all Transitions of Care (TOC) activities for members following hospital admissions, emergency department visits, psychiatric admissions, detoxification episodes, rehabilitation stays, and other qualifying transitions.
• Complete required outreach and documentation within New York State and MCO-required timeframes.
• Coordinate discharge planning with hospitals, inpatient facilities, outpatient providers, and community agencies.
• Collaborate with assigned Care Managers to ensure seamless continuity of care.
• Monitor transition metrics and identify barriers that may impact successful community reintegration.
• Track TOC completion rates and ensure compliance with Health Home standards. Managed Care Organization (MCO) Liaison
• Serve as the primary point of contact between the agency and Managed Care Organizations.
• Respond to MCO requests for clinical information, documentation, and care coordination.
• Participate in case conferences and interdisciplinary meetings with MCO representatives.
• Assist with resolving authorization, eligibility, and care coordination concerns.
• Maintain positive working relationships with MCO partners.
• Monitor and communicate changes in MCO policies and requirements to staff. Long-Term Excluded Setting (LTES) Management
• Monitor all members residing in Long-Term Excluded Settings (hospitals, nursing homes, incarceration, and any other excluded setting).
• Maintain tracking systems for LTES eligibility and enrollment status.
• Coordinate discharge planning with facilities and community providers.
• Ensure compliance with New York State Health Home enrollment requirements.
• Monitor timelines to support timely reenrollment when appropriate, following policies and procedures set forth by this CMA, HHUNY and the DOH - whichever is soonest.
• Maintain accurate documentation regarding member status and eligibility. Quality Assurance & Compliance
• Assist in quality assurance department and monitor assigned operational workflows to ensure compliance with New York State Department of Health Health Home regulations.
• Review documentation for completeness, accuracy, and timeliness.
• Assist in quality improvement initiatives and corrective action planning.
• Prepare monthly reports related to HARP, CORE, TOC, LTES, and MCO performance metrics.
• Identify workflow inefficiencies and recommend process improvements.
• Assist with internal audits and external reviews as requested. Staff Support & Education
• Serve as a subject matter expert regarding HARP Eligibility, BEAs, CORE Services, Transitions of Care, Managed Care Organization requirements, and Long-Term Excluded Settings.
• Provide guidance and consultation to Care Managers regarding operational processes.
• Develop workflow tools, training materials, and educational resources.
• Participate in onboarding and ongoing staff education related to assigned responsibilities.

QualificationsEducation Bachelor's degree required, preferred in Social Work, Human Services, Nursing, Psychology, Public Health, or a related field. Master's degree preferred. Experience Minimum of three years of Health Home Care Management, Behavioral Health, or Care Coordination experience. Experience with New York State Health Home regulations required. Experience with

HARP, CORE

Services, Managed Care Organizations, and Transitions of Care preferred. Previous operations specialisty or lead experience preferred. Knowledge, Skills, and Abilities

• Comprehensive knowledge of New York State Health Home regulations.
• Understanding of HARP eligibility, BEAs, and CORE Services.
• Knowledge of Medicaid Managed Care requirements.
• Strong organizational and project management skills.
• Excellent written and verbal communication.
• Ability to prioritize multiple responsibilities while meeting regulatory deadlines.
• Strong problem-solving and critical-thinking abilities.
• Proficiency with electronic health records, MAPP/HHTS (or successor platforms), Microsoft Office, and other care management software.
• Ability to work collaboratively with interdisciplinary teams and community partners. Performance Expectations
• Maintain timely completion of HARP conversations and BEAs.
• Ensure appropriate and timely referrals to CORE Services.
• Maintain compliance with all Transition of Care requirements.
• Ensure timely responses to Managed Care Organization requests.
• Maintain accurate tracking of Long-Term Excluded Setting members.
• Meet all documentation and regulatory timeframes.
• Support agency quality improvement initiatives.
• Foster collaborative relationships with internal staff and external partners.
• Assist in improving Health Home quality metrics and operational efficiency. Physical Requirements
• Ability to sit, stand, and use a computer for extended periods.
• Occasional travel to hospitals, community providers, or agency locations as needed.
• Ability to lift up to 20 pounds occasionally.

Work Environment This position is performed in an office and community-based setting and requires frequent interaction with healthcare providers, Managed Care Organizations, community partners, and Health Home staff. The position may require flexibility to respond to urgent care coordination needs while maintaining compliance with all agency, New York State Department of Health, and Managed Care Organization requirements.

Pay:

From $30.00 per hour Expected hours: 40.0 per week

Benefits:

401(k) matching 403(b) Dental insurance Employee assistance program Family leave Flexible schedule Flexible spending account Health insurance Health savings account Mileage reimbursement Paid time off Parental leave Vision insurance

Work Location:

In person