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CareSource

Member-first health plan: Marketplace, Medicare, Medicaid

Vice President, Market Operations

Business OperationsConfirmed live in the last 24 hours
Full-timeOhio, USA

About the Job

Requirements

  • A Bachelor of Science degree in finance, business, or a health care field, or equivalent work experience, is required.
  • Five years of health plan operations experience, such as claims, enrollment, or provider agreements, is required.
  • Five years of experience leading division and corporate initiatives to drive systemic change and consumer adoption of health insurance and engagement initiatives is required.
  • Five years of management experience in a managed care setting is required.
  • Intermediate proficiency with Microsoft Office is required.
  • Knowledge of product requirements across regulatory, operations, clinical, reporting, and compliance areas is required.
  • Ability to attract, manage, and develop team members is required.
  • Ability to maintain confidentiality and act in the company's best interest is required.
  • Oral, written, and interpersonal communication skills are required.
  • Leadership experience and skills are required.
  • Ability to act with diplomacy and sensitivity to cultural diversity is required.
  • Ability to adapt to a changing environment is required.
  • Health plan financial and administration management acumen is required.
  • Strategic management skills are required.
  • Conflict resolution skills are required.
  • Planning, problem identification, and resolution skills are required.
  • Annual influenza vaccination is a condition of continued employment for designated positions during influenza season; employees hired during that season have 30 days from hire to complete it.
  • Ability to travel as required by business needs is required.
  • Ability to sit or stand for extended periods in a general office environment may be required.

Responsibilities

  • Develop the overall market program strategy and business objectives, and lead alignment and collaboration to establish the organization as an industry leader in member and provider engagement, experience, and plan management.
  • Oversee more than five products within the market to ensure profitability, compliance, and growth.
  • Lead and collaborate with the Market leadership team to establish strategic and operational goals for the Market.
  • Manage more than 500,000 members across the market.
  • Identify additional growth strategies and product diversification opportunities across the market.
  • Establish key relationships with partners and stakeholders associated with market and product expansion opportunities.
  • Translate business and program vision and strategy into operational tactics, and build the organizational support and infrastructure needed to execute them.
  • In new markets, lead program implementation, allocate implementation team resources, facilitate ongoing operations, and establish post-implementation strategy and goals to mitigate program risks.
  • Oversee day-to-day market program operations and establish controls to ensure requirements are in place.
  • Lead regular market business reviews with stakeholder groups, including human resources, information technology, finance, Business Partner Group, quality improvement, and Care4U, to ensure market requirements are met.
  • Develop, translate, and execute key strategies and functional or operational requirements for the market.
  • Facilitate the leadership team in establishing organizational goals and priorities that align and focus the organization.
  • Ensure market operations achieves short- and long-term strategic priorities effectively and efficiently.
  • Oversee allocation of staffing resources and responsibilities for market operations.
  • Initiate and oversee operational plans and initiatives to create cross-functional capabilities across key functional areas.
  • In collaboration with corporate compliance, escalate and resolve key issues to maintain contract compliance and responsiveness; maintain knowledge of the regulatory environment; and help translate regulatory procedures into policies, plan changes, reporting, or other operational outcomes.
  • Collaborate with Finance and Data Management to develop internal reporting for ongoing management and external reporting for compliance.
  • Work with management to oversee departmental finances and ensure budgets and sales forecasts are met.
  • Perform other job duties as requested.

Desired Qualifications

  • A master's degree is preferred.
  • Preferred experience in managed care.

About the Company

CareSource

Member-first health plan: Marketplace, Medicare, Medicaid

CareSource provides health coverage to more than 2 million members, offering Marketplace plans as well as Medicare and Medicaid products. Its core service is delivering health insurance and related care to individuals and communities through a member-first approach, aiming to improve health and well-being over time. The company operates with a focus on affordable, accessible coverage and care coordination across states, guided by its mission to place people over profits rather than simply selling plans. Key differentiators include a long history (30+ years), a national footprint with 4,500+ employees, and an emphasis on serving members’ needs and languages while promoting equal opportunity employment. The overarching goal is to help members live healthier lives by providing comprehensive coverage and support.

Company size
1,001-5,000
Company stage
Not listed
Total funding
Not listed
Headquarters
Dayton, OH
Founded
1989

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