Job Summary:
Vice President, Market Operations - Ohio is responsible for developing the overall market program strategy and business objectives; lead the alignment and collaboration to establish CareSource as the industry leader in member and provider engagement, member and provider experience, and plan management in the market.
Essential Functions:
Develop the overall market program strategy and business objectives; lead the alignment and collaboration to establish CareSource as the industry leader in member and provider engagement, member and provider experience, and plan management in the market
Responsible for oversight of more than five products (e.g.; ABD – A, ABD – K, Magi, AFK, expansion, MSY – FFS, CFC, Marketplace, DSN, and Duals) within the market to ensure profitability, compliance, and growth.
Responsible for leading and collaborating with the Market leadership team to establish strategic and operational goals for the Market.
Responsible for managing over 500k members across the market.
Work across the market to identify additional growth strategies and product diversification.
Responsible for establishing key relationships with partners and stakeholders associated with market and product expansion opportunities.
Primary responsibility for translating business/program vision and strategy into operational tactics and building the necessary organizational support and infrastructure
In new markets, lead program implementation, allocate implementation team resources, and facilitate ongoing operations; establish post-implementation strategy and goals to mitigate program risks
Ongoing responsibility for day-to-day program operations for market, including establishing and overseeing controls to ensure requirements are in place
Responsible for leading regular market business reviews with various stakeholder groups (including, but not limited to, human resources, information technology, finance, Business Partner Group, quality improvement, and Care4U) to ensure market requirements are being met
Develop, translate, and execute key strategies or functional/operational requirements for market
Facilitate leadership team in the establishment of organizational goals and priorities to align and focus the organization
Ensure market operations achieves its short- and long-term strategic priorities with maximum effectiveness and efficiency
Oversee allocation of staffing resources and responsibilities for market operations
Initiate and oversee operational plans and initiatives to create cross-functional capabilities required across key functional areas
In collaboration with corporate compliance, escalate key issues and work to resolve to maintain contract compliance and responsiveness, develop and maintain in-depth knowledge of the company’s regulatory environment, and assist in transforming regulatory procedures into polices, plan changes, reporting or other operational outcomes
Collaborate with Finance and Data Management to develop internal reporting for ongoing management as well as production of external reporting for compliance
Work with management to oversee departmental finances/budget and sales forecast/budget are met
Perform any other job duties as requested
Education and Experience:
Bachelor of Science degree in finance, business, or health care field or equivalent work experience is required
Master’s degree is preferred
Five (5) years of health plan operations (IE – claims, enrollment, provider agreements, etc.) experience is required
Five (5) years of 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 managed care setting is required
Competencies, Knowledge and Skills:
Intermediate proficiency level with Microsoft Office
Knowledge of full range of product requirements from regulatory, operations, clinical, reporting and compliance
Critical listening and systematic thinking…