AVP, Integrated Care Management Operations, Preferred Experience in Managed Care & DUALS/FIDE

🔥 12 hours ago

🇺🇸 United States – Remote

💵 $150k - $300k / year

⏰ Full Time

🔴 Lead

⚙️ Operations

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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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

• Collaborate with Market and Corporate Leadership to support integrated care strategy and operations across multiple high-volume and/or complex population markets • Provide strategic direction, leadership, and oversight for integrated care activities across the continuum of care • Develop, standardize, scale, implement, and evaluate integrated care programs, operating models, processes, innovations, and evidence-based practices • Establish strategic, operational, and financial plans supporting integrated care effectiveness, efficiency, growth, and market needs • Develop performance targets, evaluate outcomes, identify trends, and implement corrective actions with cross-functional leaders • Review financial, utilization, quality, service, and operational reports to drive data-informed decisions • Develop staffing models, resource allocation strategies, organizational structures, accountability systems, leadership development, succession planning, and performance improvement frameworks • Advance technology, data-driven solutions, social determinants of health initiatives, health equity, and continuous quality improvement • Monitor compliance with state regulations, URAC, NCQA, HEDIS, accreditation standards, and business requirements • Foster relationships with hospitals, physicians, behavioral health providers, community organizations, government agencies, vendors, regulators, and other stakeholders • Manage departmental and program budgets and oversee resource stewardship, performance goals, and return on investment • Provide leadership and support to direct and indirect leaders • Support new business implementations, market expansions, acquisitions, and organizational transitions • Promote the organization’s mission to improve the health and well-being of members and communities served

🎯 Requirements

• Bachelor's degree in Business, health care, or another related field required • Equivalent years of relevant work experience may be accepted in lieu of required education • 10 years of clinical operations leadership and/or case management, disease management, medical management, quality improvement, or related experience required • 5 years of senior-level management experience required • 5 years of Managed Care experience in a multi-market organization required • Experience in a collaborative matrix environment preferred • Proficiency in Microsoft Office • Clinical data analysis and trending skills • Knowledge of healthcare, managed care, Medicaid/Medicare, long-term care, case/medical management, and quality improvement trends • Strong knowledge of healthcare regulations, quality improvement methodologies, and population health management • Excellent analytical, problem-solving, and decision-making skills • Commitment to the mission and values of the CareSource Family of Companies • Strong oral, written, and interpersonal communication skills • Knowledge of regulatory reporting and compliance requirements • Excellent leadership skills • Case Management or Managed Care certification preferred • Certification in Healthcare Quality preferred • Influenza vaccination required during the designated influenza season as a condition of continued employment

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Annual Influenza vaccination requirement and immunization record support • Reasonable accommodations for disabilities, medical conditions, and sincerely held religious beliefs • Remote work arrangement • Travel is not typically required