Job Summary:

The Program Manager, Market Vendor Performance is responsible for coordinating programs that support the delivery of member benefits including durable medical equipment (DME), home modification, and wheelchair repair services. This role partners with internal stakeholders and external service providers to improve member experience, monitor operational performance, drive continuous improvement and ensure compliance with contractual and regulatory requirements. The Program Manager influences outcomes through collaboration, data-driven decision making, and operational leadership. This role focuses on improving the product and member experience, ensuring regulatory compliance, and supporting operational excellence to enable safe community living for members.

Essential Functions:

• Manage and support initiatives to improve member interactions with plan services and benefits.
• Develop, monitor, and report on key performance indicators (KPI’s), Service level agreements (SLA’s) and operational dashboards with attention on timely delivery of services, quality metrics, member outcomes and ensuring high-quality service delivery.
• Lead operational reviews to identify trends, risks, and opportunities for improvement.
• Coordinate implementation of new initiatives and operational processes
• Support the alignment of products and services with member needs, with attention to compliance, equity, accessibility, and quality.
• Monitor and evaluate the end-to-end product service experience, identifying opportunities for improvement, streamlining operational workflows, improving member experience, reduce administrative burden, and escalation as appropriate.
• Support the development of policies and procedures and document workflows, standard operating procedures and business requirements.
• Serve as the operational liaison for contracted service providers, monitoring performance, resolving issues, facilitating communication, and ensuring alignment with organizational goals and contractual expectations.
• Facilitate issue resolution with attention to addressing root causes among internal teams and external partners
• Partner with internal stakeholders, including operations, grievances and appeals, compliance, and clinical teams, to support initiative execution and alignment with organizational goals.
• Assist with communication and coordination with external stakeholders, including vendors and regulatory partners.
• Support the development and administration of training and communication relevant to DME, wheelchair repairs, home modification and all else within scope of work to applicable stakeholders.
• Provide analysis and insight on data pertinent to the role, including, but not limited to, DME trends in terms of cost, supplier volume and supplier performance.
• Collaborate in the creation of materials needed to review SLAs, KPIs, status and more, as relevant to the role responsibilities.
• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's degree in healthcare management, business, or related field required
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Seven (7) years of experience in healthcare operations, member services, or product experience roles required
• Experience supporting vendor management and service delivery improvement initiatives required
• Working knowledge of DME services, healthcare regulations, and compliance requirements required
• Experience using operational metrics, dashboards, and data analysis to drive performance improvements preferred

Competencies, Knowledge and Skills:

• Strong communications, analytical, and organizational skills
• Program Management: Ability to coordinate multiple initiatives simultanteously while balancing competing priorities.
• Analytical Thinking: Uses data, metrics, and performance trends to identify opportunities and recommend solutions.
• Operational Effectiveness: Ability to support process improvements and tack measurable results.
• Relationship Building: Builds effective working relationships internally and externally while building consensus to achieve shared goals.
• Member-Centric Focus: Demonstrates commitment to improving member experience and outcomes.
• Knowledge of Medicare Advantage rules and regulations.
• Knowledge of MassHealth, or other Medicaid program regulations.

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation Range:

$94,100.00 - $164,800.00

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 (hourly/salary):

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

 

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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Brand=Commonwealth Care Alliance