Senior Director, Supplemental Providers – Enhanced Benefits

🕒 il y a 1 mois

🇺🇸 États-Unis – Télétravail

💵 $135 600 - $237 400 / an

⏰ Temps Plein

🟠 Senior

👔 Directeur

🦅 Parrain de Visa H1B

Cette entreprise a parrainé des visas H1B par le passé.

👻 Score fantôme 23%

Ce que ça veut dire : la probabilité que cette offre reste ouverte sans recrutement actif.Comment le lire : 60 % ou plus, on pense que c'est une offre fantôme. Un score plus bas est moins inquiétant.Comment on la calcule : ancienneté, republications, postes ouverts vs taille de l'équipe, rapidité de clôture, et si le salaire est indiqué.À noter : une estimation à partir de données publiques, pas un jugement sur l'entreprise. De vraies offres peuvent avoir un score élevé, alors prenez-le comme un indice, pas comme un fait.

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CareSource

Site WebLinkedInTous les Emplois

1001 - 5000 employés

Fondée en 30+ years

🏥 Santé

🛡️ Assurance

⚕️ Assurance santé

Healthcare • Insurance • Healthcare Insurance

CareSource est une entreprise de services de santé axée sur la fourniture d'assurances santé abordables et de solutions de soins de santé. Elle propose une large gamme de plans incluant Medicaid, le Marketplace et Medicare Advantage, visant les adultes à faible revenu, les familles, les enfants, les femmes enceintes, les personnes âgées et les personnes handicapées. De plus, CareSource fournit à ses membres des ressources pour le soutien COVID-19, des avantages dentaires, visuels et auditifs, ainsi que des services de pharmacie. L'entreprise met l'accent sur l'accès facile à la gestion des soins de santé via des plateformes en ligne et une application mobile.

Description

• Oversee, administer, and manage the performance of supplemental vendor relationships and enhanced benefit programs across assigned markets and products • Establish and maintain compliant, efficient, and effective processes supporting contractual requirements, regulatory obligations, operational standards, and organizational objectives • Serve as enterprise subject matter expert for supplemental vendors and enhanced benefit strategy • Develop and lead enterprise strategy for supplemental vendor management and enhanced/value-added Medicaid benefits across all markets • Monitor vendor and program performance through metrics, service levels, audits, reporting, and issue escalation • Create and implement scalable governance frameworks for vendor oversight and enhanced benefit administration • Coordinate with internal departments to support 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 and enhanced benefit vendors • Partner with market and product leadership to design, evaluate, and optimize enhanced benefit offerings • Support implementation, maintenance, and optimization of enhanced benefits across markets • Review performance trends, identify operational risks or gaps, and implement corrective actions, remediation plans, or process changes • Establish enterprise 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 programs, and maternal and infant support • Conduct vendor due diligence and maintain 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 Federal Medicaid managed care regulations, CMS requirements, state contractual obligations, NCQA standards, delegation oversight requirements, and privacy and data security regulations • Ensure enhanced benefits are accurately documented in state filings, member materials, and operational workflows • Lead and develop a high-performing vendor management and enhanced benefits team • Build scalable processes, operational infrastructure, and talent capabilities to support enterprise growth • Perform other job-related duties as requested

🎯 Exigences

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field required • 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 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 • General office environment; may be required to sit or stand for extended periods • Project Management Professional (PMP) certification preferred • Certified in Healthcare Compliance (CHC) and/or Certified in Healthcare Privacy Compliance (CHPC) preferred • Additional certifications related to managed care operations, quality, compliance, or vendor oversight preferred

🏖️ Avantages

• Bonus tied to company and individual performance • Comprehensive total rewards package • Employee total well-being support • Up to 25% travel to meetings, trainings, and conferences