Senior Director, Supplemental Providers – Enhanced Benefits

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🕒 Ontem

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $135.600 - $237.400 / ano

⏰ Tempo Integral

🟠 Sênior

👔 Diretor

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CareSource

SiteLinkedInTodas as Vagas

1001 - 5000 funcionários

Fundada em 30+ years

🏥 Saúde

🛡️ Seguros

⚕️ Seguro de Saúde

Healthcare • Insurance • Healthcare Insurance

CareSource é uma empresa de serviços de saúde focada em fornecer soluções acessíveis de seguro saúde e assistência médica. Oferece uma ampla gama de planos, incluindo Medicaid, Marketplace e Medicare Advantage, direcionados a adultos de baixa renda, famílias, crianças, gestantes, idosos e pessoas com deficiência. Além disso, a CareSource oferece aos membros recursos para suporte ao COVID-19, benefícios odontológicos, de visão e audição, bem como serviços de farmácia. A empresa enfatiza o fácil acesso ao gerenciamento de saúde por meio de plataformas online e um aplicativo móvel.

Descrição

• Oversee, administer, and ensure performance of supplemental vendor relationships and enhanced benefit programs across assigned markets and products • Establish and maintain compliant, efficient processes supporting contractual requirements, regulatory obligations, operational standards, and organizational objectives • Develop and lead enterprise strategy for supplemental vendor management and enhanced/value-added Medicaid benefits across all markets • Monitor vendor and program performance using metrics, service levels, audits, reporting, and issue escalation • Create scalable governance frameworks for vendor oversight and enhanced benefit administration • Coordinate with internal departments on administration and continuous improvement of vendor-supported services and enhanced benefits • Secure pricing guardrails, actuarial inputs, and Finance approval before sourcing or renegotiating vendor contracts • Review and approve forecasts, budgets, and accrual projections for supplemental/enhanced benefit vendors • Partner with market and product leadership to design, evaluate, and optimize enhanced benefit offerings • Support implementation, maintenance, optimization, operational readiness, documentation, and ongoing administration of enhanced benefits • Identify operational risks or gaps and implement corrective actions, remediation plans, or process changes • Establish enterprise vendor scorecards and performance management processes • Participate in vendor selection, contract reviews, renewals, amendments, negotiations, and RFP processes • Support audits, readiness reviews, corrective action plans, and regulatory responses • Oversee operational administration and performance of enhanced benefits, including OTC, nutrition, and maternal and infant support programs • Conduct vendor due diligence and ongoing performance monitoring • Ensure compliant and consistent benefit implementation while accommodating state-specific requirements • Monitor benefit utilization, member engagement, ROI, quality impact, and operational effectiveness • Partner with analytics teams to assess benefit effectiveness and identify optimization opportunities • Ensure compliance with Medicaid regulations, CMS requirements, state contracts, NCQA standards, delegation oversight, and privacy/data security regulations • Ensure accurate documentation in state filings, member materials, and operational workflows • Lead and develop the vendor management and enhanced benefits team • Build scalable processes, operational infrastructure, and talent capabilities for enterprise growth • Perform other job-related duties as requested

🎯 Requisitos

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field required • Master's degree preferred • Equivalent years of relevant work experience may be accepted in lieu of required education • Eight (8) years leading enterprise or multi-state vendor management and/or Medicaid benefit programs within a health plan environment required • Five (5) years of progressive leadership experience in Medicaid managed care, healthcare operations, vendor management, product/benefit strategy, or payer operations required • Deep knowledge of Medicaid managed care operations • Deep knowledge of enhanced/value-added Medicaid benefits • Deep knowledge of CMS and state Medicaid regulations • Deep knowledge of delegation oversight • Deep knowledge of managed care contracting • Deep knowledge of population health and health equity strategies • Familiarity with healthcare compliance, privacy, delegation oversight, and regulatory operations required • Strong executive communication and stakeholder management skills • Exposure to complex vendor portfolios, contract administration, audits, and operational improvement initiatives preferred • PMP certification preferred • CHC and/or CHPC certification preferred • Additional certifications related to managed care operations, quality, compliance, or vendor oversight preferred • Ability to work in a general office environment and sit or stand for extended periods • Up to 25% regular travel may be required

🏖️ Benefícios

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Employee total well-being support • Remote work arrangement • Up to 25% travel to attend meetings, trainings, and conferences