CareSource
Clinical Operations - Business Strategy Lead - R11185
CareSource, Dayton, Ohio, United States, 45444
Clinical Operations - Business Strategy Lead - R11185
Job Summary
Clinical Operations – Business Strategy Lead serves as a subject matter expert and liaison between internal clinical partners/designees to capture business requirements. The role coordinates with clinical partners, key stakeholders, and vendors to ensure requirements are met and initiatives are executed effectively.
Essential Functions
Serve as the partner’s advocate, anticipating and resolving problems with the strategic partner.
Coordinate between CareSource and clinical partners/vendors to maximize 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.
Develop issue‑prevention strategies, solutions, and participate in negotiating/implementing chosen actions.
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 is preferred.
Competencies, Knowledge And Skills
Advanced proficiency with Microsoft Office Suite including Outlook, Word, Excel and PowerPoint.
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 and 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 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.
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.
Seniority level Mid‑Senior level.
Employment type Full‑time.
Job function Research, Analyst, and Information Technology.
Industries Insurance.
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 partner’s advocate, anticipating and resolving problems with the strategic partner.
Coordinate between CareSource and clinical partners/vendors to maximize 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.
Develop issue‑prevention strategies, solutions, and participate in negotiating/implementing chosen actions.
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 is preferred.
Competencies, Knowledge And Skills
Advanced proficiency with Microsoft Office Suite including Outlook, Word, Excel and PowerPoint.
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 and 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 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.
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.
Seniority level Mid‑Senior level.
Employment type Full‑time.
Job function Research, Analyst, and Information Technology.
Industries Insurance.
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