Director, Enrollment Operations – Duals Special Needs Enrollment Experience Required

Job not on LinkedIn

🔥 6 minutes ago

🇺🇸 United States – Remote

💵 $113k - $197.7k / year

⏰ Full Time

🔴 Lead

⚙️ Operations

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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

• Lead end-to-end enrollment operations across markets, including prospective enrollment, auto-enrollment, disenrollment, and reinstatement • Lead enrollment operations integration for newly acquired or merging health plans, including system alignment, data migration, and process standardization • Establish and lead an enterprise enrollment oversight framework with reconciliation methodologies, cross-system validation, and executive reporting • Establish and execute enrollment operations strategy aligned with product growth, regulatory requirements, and market expansion • Partner with IT on system enhancements, data governance, and integration strategies • Manage vendor relationships and enrollment partners, ensuring SLA performance and resolving enrollment exceptions • Drive transformation initiatives, including automation, AI-enabled reconciliation, and process optimization • Monitor KPIs and operational metrics to identify risks, compliance gaps, trends, and improvement opportunities • Lead, develop, and manage enrollment operations teams • Oversee enrollment, regulatory compliance, financial, and vendor reconciliation activities • Ensure compliance with CMS, Medicaid, and state regulations through audit readiness, audit responses, legislative monitoring, and corrective action plans • Manage CMS 834/820 transactions, state data feeds, and reconciliation processes • Establish and enforce enrollment policies, procedures, and internal controls • Perform other job-related duties as requested

🎯 Requirements

• Bachelor's degree in accounting, finance, healthcare management or related field required • Equivalent years of relevant work experience may be accepted in lieu of required education • Seven (7) years of leadership and management experience required • Five (5) years of business operations or similar experience, preferably in a health care environment, required • Medicaid managed care, Medicare Advantage, Dual Special Needs Plan (D-SNP), or related healthcare experience required • Demonstrated experience leading system integrations, mergers, or operational transformations • Deep knowledge of enrollment operations, CMS regulations, Medicaid processes, and healthcare operational workflows • Proven ability to design and operationalize enterprise oversight frameworks, including dashboards and reconciliation models • Familiarity with healthcare systems such as TriZetto EAM, Facets, MARx, HPMS, and MMIS platforms • Strong knowledge of compliance, audit, and regulatory frameworks, including internal and external controls • Ability to develop long-term enrollment strategy and execute near-term initiatives • Strong analytical and problem-solving skills with the ability to manage competing priorities and timelines • Demonstrated leadership capability, including team development, engagement, and performance management • Ability to effectively interact with all levels of management • Advanced computer skills, including Microsoft Office; ability to learn new technologies quickly • Strong interpersonal, written, and verbal communication skills, including change management capabilities • General understanding of IT environments preferred • Ability to travel as required by the needs of the business

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Employee total well-being support