Clinical Operations

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:

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):

Organization Level Competencies

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Influence Others

• Pursue Personal Excellence

• Understand the Business