Senior Director, Supplemental Providers – Enhanced Benefits

Job not on LinkedIn

🔥 0 minutes ago

🇺🇸 United States – Remote

💵 $135.6k - $237.4k / year

⏰ Full Time

🟠 Senior

👔 Director

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

Apply Now

Find Similar Remote Jobs

Set Up Email Alert For New Jobs

📊 Check your resume score for this job

Improve your chances of getting an interview by checking your resume score before you apply.

Upload Resume

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

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

🎯 Requirements

• Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field required • Master's degree preferred • 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 of 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 • Exposure to complex vendor portfolios, contract administration, audits, and operational improvement initiatives preferred • PMP certification preferred • CHC and/or CHPC certification preferred • Additional certifications related to managed care operations, quality, compliance, or vendor oversight preferred • Ability to work in a general office environment and sit or stand for extended periods • Up to 25% regular travel may be required

🏖️ Benefits

• Bonus tied to company and individual performance may be available • Comprehensive total rewards package • Employee total well-being support • Remote work arrangement • Up to 25% travel to attend meetings, trainings, and conferences