Director, Network Performance and Strategy – Preferred Experience in Managed Care

🔥 3 minutes ago

🇺🇸 United States – Remote

💵 $113k - $197.7k / year

⏰ Full Time

🔴 Lead

👔 Director

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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

• Provide strategic leadership for the enterprise Network Performance and Strategy function across markets and lines of business • Develop standardized frameworks for evaluating provider performance, network adequacy and access, utilization, affordability, leakage/OON utilization, quality, contracting performance, and other network measures • Translate network performance intelligence into strategies improving market performance, affordability, quality, network adequacy, growth, and competitive positioning • Advise network leadership using enterprise benchmarks, insights, and scalable solutions • Establish enterprise standards and methodologies for network performance management • Lead development of network performance reporting, analytics, decision-support tools, automation, AI, and proprietary platforms • Partner with Medical Economics and Actuarial leadership on network performance methodologies and analytical models • Partner with Value-Based Contracting leadership on provider segmentation, performance insights, and VBC strategy • Partner with Network Contracting on contracting priorities, provider targeting, reimbursement strategies, and network optimization • Identify and prioritize enterprise network opportunities and develop business cases • Oversee deployment of network performance capabilities across markets, including adoption, change management, and measurable business impact • Evaluate emerging technologies, data sources, vendors, and industry practices • Develop and manage the team's operating plan, talent strategy, priorities, and resource allocation • Represent Network Performance & Strategy with executive leadership and cross-functional stakeholders • Establish accountability for measurable outcomes and evaluate team impact on network performance and business objectives • Perform other job-related duties as requested

🎯 Requirements

• Bachelor's degree in healthcare administration, business, analytics, economics, public health, or related field required • Equivalent years of relevant work experience may be accepted in lieu of required education • Ten (10) years of progressive experience in managed care, healthcare strategy, network management, provider performance, medical economics, healthcare analytics, or related areas required • Five (5) years of experience in leadership roles required • Experience in Medicaid managed care and/or Medicare Advantage preferred • Experience with network optimization, provider performance, value-based care, reimbursement, or medical cost management preferred • Demonstrated understanding of health-plan network strategy, provider performance, healthcare economics, and managed-care operations • Skilled in using advanced analytics, AI, or technology-enabled operating models • Skilled in leading enterprise capabilities across a geographically dispersed health-plan organization • Familiarity with operating across multiple markets, business units, or lines of business • Strong executive communication, relationship management, and strategic problem-solving skills • Skilled in enterprise network strategy • Skilled in network performance management • Familiarity with healthcare economics • Executive leadership skills • Cross-functional influence skills • Skilled in developing and analyzing Market strategy • Knowledgeable in provider performance • Change management skills • Data-driven decision-making skills • Organizational leadership skills • No licensure or certification required • Up to 25% regular travel may be required

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Substantial and comprehensive total rewards package • Total well-being support • Remote work arrangement

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