Senior Director, Supplemental Providers – Enhanced Benefits
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Job Description
Senior Director overseeing Medicaid supplemental benefits and vendor strategy for CareSource health plans. Leading compliant vendor operations, benefit optimization, governance, and enterprise teams.
Responsibilities:
- Oversee, administer, and ensure performance of supplemental vendor relationships and enhanced benefit programs across assigned markets and products
- Establish and maintain compliant, efficient processes supporting contractual requirements, regulatory obligations, operational standards, and organizational objectives
- Develop and lead enterprise strategy for supplemental vendor management and enhanced/value-added Medicaid benefits across all markets
- Monitor vendor and program performance using metrics, service levels, audits, reporting, and issue escalation
- Create scalable governance frameworks for vendor oversight and enhanced benefit administration
- Coordinate with internal departments on administration and continuous improvement of vendor-supported services and enhanced benefits
- Secure pricing guardrails, actuarial inputs, and Finance approval before sourcing or renegotiating vendor contracts
- Review and approve forecasts, budgets, and accrual projections for supplemental/enhanced benefit vendors
- Partner with market and product leadership to design, evaluate, and optimize enhanced benefit offerings
- Support implementation, maintenance, optimization, operational readiness, documentation, and ongoing administration of enhanced benefits
- Identify operational risks or gaps and implement corrective actions, remediation plans, or process changes
- Establish enterprise vendor scorecards and performance management processes
- Participate in vendor selection, contract reviews, renewals, amendments, negotiations, and RFP processes
- Support audits, readiness reviews, corrective action plans, and regulatory responses
- Oversee operational administration and performance of enhanced benefits, including OTC, nutrition, and maternal and infant support programs
- Conduct vendor due diligence and ongoing performance monitoring
- Ensure compliant and consistent benefit implementation while accommodating state-specific requirements
- Monitor benefit utilization, member engagement, ROI, quality impact, and operational effectiveness
- Partner with analytics teams to assess benefit effectiveness and identify optimization opportunities
- Ensure compliance with Medicaid regulations, CMS requirements, state contracts, NCQA standards, delegation oversight, and privacy/data security regulations
- Ensure accurate documentation in state filings, member materials, and operational workflows
- Lead and develop the vendor management and enhanced benefits team
- Build scalable processes, operational infrastructure, and talent capabilities for enterprise growth
- Perform other job-related duties as requested
Requirements:
- Bachelor's degree in Healthcare Administration, Business Administration, Public Health, or related field required
- Master's degree preferred
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Eight (8) years leading enterprise or multi-state vendor management and/or Medicaid benefit programs within a health plan environment required
- Five (5) years of progressive leadership experience in Medicaid managed care, healthcare operations, vendor management, product/benefit strategy, or payer operations required
- Deep knowledge of Medicaid managed care operations
- Deep knowledge of enhanced/value-added Medicaid benefits
- Deep knowledge of CMS and state Medicaid regulations
- Deep knowledge of delegation oversight
- Deep knowledge of managed care contracting
- Deep knowledge of population health and health equity strategies
- Familiarity with healthcare compliance, privacy, delegation oversight, and regulatory operations required
- Strong executive communication and stakeholder management skills
- Exposure to complex vendor portfolios, contract administration, audits, and operational improvement initiatives preferred
- PMP certification preferred
- CHC and/or CHPC certification preferred
- Additional certifications related to managed care operations, quality, compliance, or vendor oversight preferred
- Ability to work in a general office environment and sit or stand for extended periods
- Up to 25% regular travel may be required
Benefits:
- Bonus tied to company and individual performance may be available
- Comprehensive total rewards package
- Employee total well-being support
- Remote work arrangement
- Up to 25% travel to attend meetings, trainings, and conferences
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