Sr. Director, Network Strategic Initiatives and Vendor Performance(Preferred Experience In Durable Medical Equipment & Preferred Location Northeast)

Commonwealth Care Alliance (CCA) is a nonprofit, mission-driven health plan and care delivery organization designed for individuals with the most significant needs. As an affiliate of CareSource, a nationally recognized nonprofit managed care organization with over 2 million members across multiple states, CCA serves individuals enrolled in Medicaid and Medicare in Massachusetts through the Senior Care Options and One Care programs and its care delivery enterprises. CCA is dedicated to delivering comprehensive, integrated, and person-centered care, powered by its unique model of uncommon care, which yields improved quality outcomes and lower costs of care.

Job Summary:

The Sr. Director of Network Strategic Initiatives and Vendor Performance is responsible for developing and implementing strategies to enhance member retention, improve product experience, and ensure the seamless delivery of critical services, including oversight of DME vendor relationships, home modifications and wheelchair repair services. This role focuses on delivering exceptional member satisfaction, maintaining compliance with healthcare regulations, and driving operational excellence to ensure members are able to live safely in the community.

Essential Functions:

Product and Service Experience

• Lead efforts to improve member interactions with plan services and benefits.
• Ensure alignment of products and services with member needs, emphasizing equity, accessibility, and quality.
• Regularly review and refine the end-to-end product service experience, identifying pain points and opportunities for improvement.

Home Modification Vendor and Service Oversight

• Serve as the primary point of contact for home modification vendors, ensuring high-quality service delivery and adherence to contractual obligations.
• Establish and monitor service level agreements (SLAs) with vendors, focusing on timely and quality delivery of home modifications.
• Oversee the development of policies and procedures related to home modifications.

DME Vendor and Service Oversight

• Serve as the primary point of contact for DME vendors, ensuring high-quality service delivery and adherence to contractual obligations.
• Establish and monitor service level agreements (SLAs) with vendors, focusing on timely delivery of medical equipment.
• Oversee the development of policies and procedures related to DME procurement, repair, and replacement services.

Wheelchair Repair Vendor and Service Oversight

• Serve as the primary point of contact for wheelchair repair vendors, ensuring high-quality service delivery and adherence to contractual obligations.
• Establish and monitor service level agreements (SLAs) with vendors, focusing on timely repair and maintenance of wheelchairs.
• Oversee the development of policies and procedures related to wheelchair repair services.

Network Strategic Initiatives

• Lead a team of provider network process leads, providing coaching and performance management.
• Partner with internal stakeholders, including operations, compliance, and clinical teams, to align initiatives with organizational goals.
• Serve as a liaison between the organization and external vendors, regulators, and member advocacy groups.
• Serve as the Provider Network lead for key department-wide Quality, Market, and Compliance initiatives, including but not limited to Health Equity Strategy, NCQA Net Deliverables, member retention, and other EOHHS and/or regulator submissions as needed.
• Develops, monitors and submits regular service quality key indicators and deliverables for each department to improve business results with overall provider network team's quality measures and while adhering to compliance/government requirements (NCQA, CMS, EOHHS and related agencies).
• Coordinate and monitor performance of all network related Quality and Affordability Initiatives (QAIs), including being the business owner of some initiatives and a supporting function in others
• Defines, implements and revise operational policies and guidelines for the provider network organization including change control structures, SOP's and policies and procedures.
• Support Provider Network and Market Leadership structures in strategic planning, goal setting, and organizational performance management and reporting based on department wide KPIs
• Coordinate and run key leadership meetings inclusive of department leadership, all-department, and other market leadership cross functional meetings.
• In conjunction with Provider Relations leadership, develop and implement an end-to-end provider experience improvement strategy and model

Education and Experience:

• Bachelor's degree in related field or equivalent years of relevant work experience is required
• Master's degree in a related field is preferred
• A minimum of seven (7) years of experience driving performance and process improvements, is required in the health care insurance industry
• Minimum of five (5) years of leadership and management is required
• Experience in cross-functional health care insurance operations such as the following is required: Finance/Actuarial, sales/marketing, consumer experience/call center, grievance and appeals, population health management, including behavioral health, wellness, pharmacy and ancillary benefits, provider contracting, credentialing, enrollment, pricing, services and data maintenance, enrollment and revenue cycle operations, claims and encounters, and member and benefits configuration.
• Experience with Government-regulated (Federal and/or State) health insurance products including Medicaid, Medicare and Marketplace is required

Competencies, Knowledge and Skills:

• Ability to lead direct reports and matrixed teams to successfully deliver complex initiatives within budget and against immovable deadlines
• Extensive knowledge of Project Management methodologies
• Exceptional collaboration, relationship building, and influencing skillset
• Flexibility in leading organizational change
• Exceptional planning and time management skills
• Excellent listening and critical thinking skills
• Excellent decision-making and problem-solving skills
• Ability to effectively interact at all levels within the organization
• Excellent written and verbal communication skills
• Hands on proficiency in Microsoft Office tools, including Project, Outlook, Word, PowerPoint and Excel
• Business acumen and politically astute ability to act with diplomacy and sensitivity to cultural diversity
• Ability to work independently and within a team environment

Licensure and Certification:

• Certified Six Sigma Black Belt is preferred
• Program Management Professional is preferred

Working Conditions:

• General office environment; may be required to sit/stand for long periods of time
• Infrequent, short-term travel may be required

Compensation Range:
$135,600.00 - $237,400.00 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

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.

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