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 $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

Compensation Range:

$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 (hourly/salary):

Salary

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.

#LI-SW2

Brand=CareSource