OH Market Program Management Director(Preferred Experience In Managed Care)

Job Summary:

The OH Market Duals Program Management Director assists the Vice President, Duals Products with oversight of program implementations, compliance oversight, operational performance, program growth, clinical and care management effectiveness, Quality and Affordability Initiatives (QAI) pipeline development, and execution of other activities which support program management effectiveness and successful delivery on operational budget and other performance commitments.

Essential Functions:

• Responsible for leading Duals Program Management Operational activities across the OH Market from both a Program Management and Business Analysis perspective
• Establish strategies and goals to identify and mitigate program risks
• Identify and assist with the rapid resolution or escalation of program issues, blockers, and hindrances
• Evaluate market-specific operational process effectiveness for accomplishing market goals and objectives; manage operational process improvement activities in collaboration with Enterprise, Duals, and Market Teams
• Integrate continuous improvement and innovation into all projects and initiatives
• Develop, translate, and execute key strategies for functional/ operational requirements
• Incorporate industry standards, best practices, project management tools and techniques to support market initiatives
• Recognize and proactively manages operational dependencies and risks across Duals product initiative portfolio through effective change and risk management controls
• Lead activities ensuring the delivery of high quality, consistent initiatives that result in optimum outcomes for OH members, providers, and program goals
• Monitor performance across markets duals programs to leverage best practice and knowledge sharing for the purpose of improving outcomes through the standardization of evidence-based practices
• Assess, manage, and control program scope, schedule, and budget change impacts
• Work closely with business executives to ensure assigned programs align with business strategy and are properly funded, resourced, and managed
• Drive cross-functional communication between impacted business and IT areas
• Facilitate and drive program stakeholder meetings
• Represent program in governance meetings
• Review and approved program meeting minutes
• Interact with Integrated Dual Programs, market, and other program business partners, and build strong working relationships with key staff across market and enterprise operations
• Engages stakeholders to ensure alignment
• Provide leadership and support for product expansion
• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's degree in project management, business, public health or related field required
• Master's degree preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Six (6) years of government-regulated (Federal and/or State) health insurance products including Medicare, Medicaid, Managed Care Waiver, and FFS required
• Six (6) years of project and program management experience required
• Five (5) years of experience driving performance and process improvements in the health care insurance industry required
• Demonstrated experience implementing programs with focus on integration required

Competencies, Knowledge and Skills:

• Strong healthcare payer industry experience, including knowledge of Medicaid, Medicare, and government-regulated products
• Comprehensive operational knowledge across member and provider functions, clinical operations, and sales/business development
• Deep understanding of project management processes, tools, techniques, development lifecycles, and project management software
• Ability to manage large, complex projects from start to finish, including budgets up to

  Compensation Range

  $10M+, cross-functional teams, core members, and multiple vendors
• Strong organizational, time management, prioritization, and execution skills to deliver projects on time, on budget, and aligned with stakeholder expectations
• Excellent analytical, reporting, decision-making, problem-solving, critical thinking, and critical listening skills
• Ability to identify business problems, assess solutions, shape approaches, gain consensus, and understand business partner and stakeholder needs
• Excellent written and verbal communication skills, with the ability to interact effectively with all levels of leadership and internal/external stakeholders
• Strong relationship-building, interpersonal, leadership, training, teaching, and change agent skills
• Ability to work independently while keeping market leadership and key stakeholders informed of progress, risks, issues, opportunities, and critical information
• Business acumen, political astuteness, customer service orientation, and ability to act with diplomacy and sensitivity to cultural diversity
• Hands-on proficiency with Microsoft Office tools, including Copilot AI, Project, Outlook, Word, PowerPoint, and Excel
• Ability to think strategically, lead proactively and efficiently, and demonstrate a sense of urgency

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members and may refer members to other CareSource resources.
• Travel is not typically required

$113,000.00 - $197,700.00 CareSource takes into consideration a combination of a candidate’s education, training, and experience as well as the position’s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee’s total well-being and offer a substantial and comprehensive total rewards package.

Compensation Type

Salary

Competencies

Organization Level Competencies - Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business

This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.

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