CareSource
Job Summary
Clinical Operations - Business Strategy Lead serves a subject matter expert and serves as a liaison between internal clinical partners/designees to capture specific business requirements that must be performed by the Clinical Partner or Vendor and serves as a liaison between the Clinical Partner, Organizational Key Stakeholders and Vendors.
Essential Functions
Serve as the strategic partner's advocate anticipating and resolving problems with the strategic partner. Utilizes partner feedback to determine and recommend best practices
Coordinate between CareSource and clinical partners/vendors to maximize on the relationship and prevent escalations.
Develop and maintain expertise in clinical business processes within assigned areas and recommend innovative enterprise level strategies while addressing market specific nuances
Within assigned areas, develop issue prevention strategies, develop solutions, and participate in negotiating/implementing the chosen course of action
Facilitate or serve on enterprise clinical committees on behalf of the strategic partner to address business process related needs
Lead cross-functional meetings with stakeholders to guide the development of performance metrics feedback and identify opportunities in assigned projects
Participate in the development of business cases on behalf of the clinical leads.
Assist in the vendor selection process by participating in the RFI/RFP/RFQ process, developing total cost models, and participating in the assessment process
Act as a liaison between the clinical leads and vendor throughout the vendor lifecycle
Participate in joint operating committee meetings, and facilitate monthly operational meetings with business owners and delegated/non-delegated vendors
Perform any other job duties as requested
Education and Experience
Bachelor's degree in business, health administration, health policy or related discipline or equivalent years of relevant work experience is required
Minimum of three (3) years of experience in managed care clinical programs is preferred
Previous leadership experience is preferred
Experience with Medicaid / Medicare or other government programs with highly regulated requirements is preferred
Working knowledge of state, NCQA, and/or URAC requirements preferred
Competencies, Knowledge and Skills
Advanced proficiency level with Microsoft Office Suite including Outlook, Word, Excel and Power Point
Strong project management skills with ability to handle multiple projects within time constraints
Strong interpersonal and verbal/written communication skills with demonstrated ability to influence internal/ external constituents
Ability to speak and effectively communicate in front of individuals and groups, vendors, and executive leadership
Ability to interact with all levels of leadership, influence change, adoption of vendor management concepts, and lead cross-functional teams and initiatives
Ability to manage complex responsibilities and decisions producing long-range outcomes
Highly motivated individual with the ability to work independently in a fast paced environment with changing priorities
Proficient in interpreting business, compliance and regulatory requirements
Licensure and Certification
None
Working Conditions
General office environment; may be required to sit or stand for extended periods of time
Compensation Range $81,400.00 - $130,200.00 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
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
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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Essential Functions
Serve as the strategic partner's advocate anticipating and resolving problems with the strategic partner. Utilizes partner feedback to determine and recommend best practices
Coordinate between CareSource and clinical partners/vendors to maximize on the relationship and prevent escalations.
Develop and maintain expertise in clinical business processes within assigned areas and recommend innovative enterprise level strategies while addressing market specific nuances
Within assigned areas, develop issue prevention strategies, develop solutions, and participate in negotiating/implementing the chosen course of action
Facilitate or serve on enterprise clinical committees on behalf of the strategic partner to address business process related needs
Lead cross-functional meetings with stakeholders to guide the development of performance metrics feedback and identify opportunities in assigned projects
Participate in the development of business cases on behalf of the clinical leads.
Assist in the vendor selection process by participating in the RFI/RFP/RFQ process, developing total cost models, and participating in the assessment process
Act as a liaison between the clinical leads and vendor throughout the vendor lifecycle
Participate in joint operating committee meetings, and facilitate monthly operational meetings with business owners and delegated/non-delegated vendors
Perform any other job duties as requested
Education and Experience
Bachelor's degree in business, health administration, health policy or related discipline or equivalent years of relevant work experience is required
Minimum of three (3) years of experience in managed care clinical programs is preferred
Previous leadership experience is preferred
Experience with Medicaid / Medicare or other government programs with highly regulated requirements is preferred
Working knowledge of state, NCQA, and/or URAC requirements preferred
Competencies, Knowledge and Skills
Advanced proficiency level with Microsoft Office Suite including Outlook, Word, Excel and Power Point
Strong project management skills with ability to handle multiple projects within time constraints
Strong interpersonal and verbal/written communication skills with demonstrated ability to influence internal/ external constituents
Ability to speak and effectively communicate in front of individuals and groups, vendors, and executive leadership
Ability to interact with all levels of leadership, influence change, adoption of vendor management concepts, and lead cross-functional teams and initiatives
Ability to manage complex responsibilities and decisions producing long-range outcomes
Highly motivated individual with the ability to work independently in a fast paced environment with changing priorities
Proficient in interpreting business, compliance and regulatory requirements
Licensure and Certification
None
Working Conditions
General office environment; may be required to sit or stand for extended periods of time
Compensation Range $81,400.00 - $130,200.00 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
Fostering a Collaborative Workplace Culture
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
#J-18808-Ljbffr