Director, Member Benefits
•Provide leadership, strategic direction, budget, and performance oversight of the organization’s Member benefits platform.
•Serve as an organizational leader, driving transformation through the delivery of a comprehensive member benefit platform, ensuring alignment across markets and products.
•Support market and product leaders to identify and develop effective benefits that best serve CareSource Members and mission.
•Manage an elite team to oversee, interpret, and recommend best approach strategies to managing benefits and prior authorization.
•Collaborate with finance to ensure appropriateness of benefits in support of actuarial analyses.
•Maximize the use of business intelligence tools that support analysis and reporting of population health outcomes to drive improved benefits.
•Collaborate with Medical Directors to ensure alignment of benefits, policies, and prior authorizations.
•Responsible for the governance model to manage member benefits.
•Provide leadership and direction to staff to ensure tasks, goals and strategies are successfully achieved.
•Accountable for management of staff, infrastructure, budget, performance, and service levels.
•Perform any other job related instructions, as requested.
Education/Experience and Required Competencies:
•Bachelor’s degree in business, finance, health care administration, or related field or equivalent years of relevant work experience is required
•Advanced degree is preferred
•A minimum of eight (8) years of managerial experience in health care with strong background in financial and health outcomes is required
•A minimum of three (3) years of experience in managed care setting is preferred
•Research, data analysis and trending knowledge is required
•Proficient in BI tools (SQL, Microsoft, etc)
•Staffing and forecasting experience
•Proficient in Microsoft Office Suite to include Word, Excel and PowerPoint
•Excellent written and verbal communication skills
•Ability to develop, prioritize and accomplish goals
•Ability to work independently and within a team environment
•Attention to detail
•Effective listening and critical thinking skills
•Strong interpersonal skills and high level of professionalism
•Effective problem solving skills with attention to detail
•Registered Nurse (RN) is preferred