• Work in collaboration with the Director of Population Health and Chief Medical Officer to implement and manage the population health management strategic plan for the market
• Manage care navigation efforts of the team to ensure members are connected to appropriate resources, services, and supports that improve access to care, address identified barriers, and support quality outcomes.
• Collaborate with the Enterprise Quality Improvement teams to support initiatives in the QI work plan and drive gap closure
• Collaborate with other departments and business owners to improve quality of care and outcomes of CareSource women and children, including pregnant women, infants, children adolescents and teens through implementation of quality initiatives and interventions
• In collaboration with Clinical Operations, ensures accreditation & quality requirements are met through review, audit and monitoring of quality improvement/performance improvement and accreditation activities
• Collaborate with Network and Community Marketing teams to develop and implement wholistic and strategic community and provider engagement strategies
• Collaborate with Health Equity and social determinants of health (SDOH) teams to support community- based partnerships that reduce SBOH barriers or access to care
• Works with Enterprise and market analytics to leverage data to drive strategic community, provider and member engagement
• Participates as requested in analysis, including root cause analyses, with support from identified business owners and departments; ensures data is presented and used effectively to address accreditation, clinical monitoring, and quality and performance improvement identified issues
• In collaboration with Market Clinical Operations and Quality leadership, establishes and maintains standards and procedures for accreditation and quality reporting and documentation and communicates areas of strengths as well as opportunities for improvement to the Quality Management and Improvement Committee
• Participates in national, state and local committees and focus groups that support various sup-populations and provides input on behalf of CareSource regarding any suggested quality initiatives, programs and/or revision(s)
• Participates in internal workgroups/committees to improve quality measures, accreditation and clinical monitoring outcomes
• Provides leadership, direction and development of staff to ensure the department goals are successfully achieved
• Provides leadership and direction to staff to ensure the goals, standards, and compliance with CareSource, federal and state regulatory requirements are met
• Responsible for coaching and development of staff, and support continuing education
• Perform ongoing monitoring of staff performance, scheduling, productivity and quality to ensure optimal functioning and outcomes to meet business needs
• Perform any other job related duties as requested.

• Bachelor of Science (B.S) in health-related field required
• Master's degree in health services, public health, health care administration or other health care field preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Three (3) years in a Managed Care Organization (MCO) or other healthcare related field required, additional two (2) years strongly preferred
• Three (3) years of experience in quality or analytics required
• Three (3) years of leadership/management experience preferred
• Medicaid experience preferred

• Experience in data collection, analysis and trending of processes and outcomes
• Proficient in Microsoft Office Suite to include, Word, Excel and PowerPoint
• Experience in a high-growth business environment
• Knowledge of the principles of performance improvement, quality methodology, regulations and standards to meet health plan quality and accreditation requirements
• Working knowledge of health plan policies and procedures
• Ability to present pertinent data and recommendations clearly and concisely in a manner appropriate to end user audience(s)
• Effective problem-solving skills with attention to detail
• Ability to develop, prioritize and accomplish goals
• Strong written and verbal communication skills
• Strong interpersonal skills and high level of professionalism
• Ability to work independently and within a team environment
• Effective listening and critical thinking skills
• Display a customer service, member-focused orientation

• Current, unrestricted Registered Nurse (RN) licensure in state of practice preferred
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

• This is a mobile position, meaning that regular travel to different work locations, including homes, offices or other public settings, is essential. Will be exposed to weather conditions typical of the location and may be required to stand and/or sit for long periods of time. Must reside in the same territory they are assigned to work in; exceptions may be considered, due to business need May be required to travel greater than 50% of time to perform work duties. Required to use general office equipment, such as a telephone, photocopier, fax machine, and computer Flexible hours, including possible evenings and/or weekends as needed to serve the needs of our members
• Over 50% (Mobile) Routine travel required

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

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.