Director, Health Partner Engagement – Georgia

🕒 August 31

🇺🇸 United States – Remote

💵 $113k - $197.7k / year

⏰ Full Time

🔴 Lead

👔 Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 24%

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CareSource

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 30+ years

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

CareSource is a health services company focused on providing affordable health insurance and healthcare solutions. It offers a wide range of plans including Medicaid, Marketplace, and Medicare Advantage, targeting low-income adults, families, children, pregnant women, elderly adults, and people with disabilities. Additionally, CareSource provides members with resources for COVID-19 support, dental, vision, and hearing benefits, as well as pharmacy services. The company emphasizes easy access to healthcare management through online platforms and a mobile app.

📋 Description

• Direct, oversee, and manage relationships with key Health Partners throughout Georgia • Reduce high-cost utilization trends and ensure Health Partner contract financial targets are met or exceeded • Evaluate policy and process changes, monitor key initiative implementation, and provide leadership on initiatives affecting Health Partners • Manage the Health Partner Relations team and drive Health Partner issues to completion • Engage Health Partner associations and identify relationship and collaboration opportunities • Lead efforts promoting Quality measures and withhold targets; educate Health Partners on HEDIS and CAHPS measures and facilitate data collection • Support development and execution of negotiation plans and participate in negotiations with Contracting leadership • Lead specialists, analysts, regional concierge, and Health Partner managers while ensuring satisfaction, compliance, successful audits, and employee engagement • Direct day-to-day Health Partner Relations activities in support of market network strategy and financial targets • Execute process improvement strategies to improve inquiry response times, employee engagement, and Health Partner satisfaction • Ensure regulatory compliance, address compliance concerns, achieve accreditation standards, and participate in market audits • Provide education, leadership, analysis, and support on Cost of Care, Value-Based Reimbursement, and cost-saving initiatives • Translate goals and objectives into practical integrated solutions and deliver financial value • Develop and communicate performance improvement measurements and strategies for success • Ensure consistent Health Partner communications and portal messaging • Provide regional leadership to cross-functional teams and coordinate services to achieve market goals • Hire, manage, train, coach, and develop the Health Partner Relations team • Develop and manage the annual budget

🎯 Requirements

• Must live in Georgia • Bachelor’s degree or equivalent years of relevant work experience is preferred • Master’s degree is preferred • Minimum of seven (7) years of health plan/managed care experience is required • At least three (3) years of leadership experience preferred • Knowledge of managed care best practices • Experience driving strategic partnerships and operational improvements • Knowledge of Medicaid, Medicare, and Marketplace program managed care regulations • Strong verbal and written communication skills • Strong management, budgetary, and operations skills • Understanding of administrative, technical, and clinical dimensions of health care • Employment conditional on successful clearance of a driver’s license record check • Influenza vaccination required for designated positions during influenza season • Valid driver’s license, car, and insurance required for work-related travel • Ability to travel greater than 50% of the time • Ability to work flexible hours, including possible evenings and/or weekends

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Influenza vaccination provided/required for designated positions • Reasonable accommodations for disabilities, medical conditions, and sincerely held religious beliefs • Flexible hours, including possible evenings and/or weekends • Professional development and ongoing training • Employee leadership and coaching support