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