Job Summary: The Director, Quality Enterprise Strategy is responsible for leading the execution, performance management, and regulatory compliance of CareSource's quality programs. This role oversees quality performance, operational readiness, regulatory adherence, and quality performance improvement initiatives in alignment with the Centers for Medicare and Medicaid (CMS), State/other regulatory agencies, and contractual requirements, and functions as the primary programmatic leader for quality strategy design and execution to drive measurable improvements in quality, member experience, provider performance, and operational outcomes.Essential Functions:Lead execution of CareSource’s quality strategy for assigned Lines of Business, ensuring alignment with contractual requirements, regulatory guidance, and enterprise quality goals.Oversee quality and performance metrics, including access to care, clinical quality, beneficiary experience, network adequacy, utilization, and operational performance indicators.Monitor program performance against contractual standards, identifying risks, trends, and gaps, and implementing corrective action plans as needed.Partner with Compliance, Legal, and Internal Audit to ensure ongoing regulatory readiness, audit preparedness, and timely response to CMS, state/other regulatory agencies, and external audit findings.Direct and support quality improvement initiatives, performance interventions, and monitoring activities across clinical, operational, and provider-facing domains.Collaborate with Analytics to develop and maintain dashboards, reporting, and performance insights to support data-driven decision-making and program oversight.Support provider engagement strategies related to quality improvement/quality management requirements, performance expectations, documentation, access standards, and quality improvement/management initiatives.Coordinate with Medical Management and Network teams to support utilization management, care coordination, and network performance aligned with established standards.Lead governance routines, workgroups, and operational forums focused on quality performance, compliance, and readiness.Ensure staff training, education, and awareness related to quality program requirements, policies, and operational processes.Track regulatory changes, contract modifications, and evolving CMS/State guidance, translating requirements into operational and quality execution plans.Serve as a subject matter expert for quality programs, representing CareSource in internal leadership discussions and external engagements as needed.Perform any other job related duties as requested.Education and Experience:Bachelor's Healthcare Administration, Business, Public Health, or related field requiredMaster's Healthcare Administration, Business, or related field preferredEquivalent years of relevant work experience may be accepted in lieu of required educationSeven (7) years Experience in managed care, government-sponsored healthcare programs, or healthcare operations requiredThree (3) years Experience leading Medicare, Medicaid, or other highly regulated government healthcare programs requiredExperience with regulatory compliance, audits, contractual performance management, or accreditation readiness requiredPrior people management or matrixed leadership experience requiredCompetencies, Knowledge and Skills:Strong knowledge of quality program requirements, CMS/State oversight, and government healthcare contractingExperience with healthcare regulatory compliance, audit readiness, and corrective action planningDemonstrated ability to manage performance metrics, quality measures, and operational outcomesStrong analytical and problem-solving skills with the ability to translate data into actionable insightsExcellent communication and stakeholder management skills across clinical, operational, and executive audiencesAbility to lead and influence in a matrixed, cross-functional environmentStrong organizational, planning, and prioritization skillsHigh level of professionalism, judgment, and accountabilityProficiency in Microsoft Excel, Word, PowerPoint, and data visualization toolsLicensure and Certification: NoneWorking Conditions:General office environment; may be required to sit or stand for extended periods of timeUp to 15% (occasional) travel based on the needs of the department may be requiredCompensation Range: $113,000.00 - $197,700.00CareSource 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.
3 days ago