Job Summary:The Senior Director, Supplemental Providers & Enhanced Benefits is responsible for the oversight, administration, and performance of supplemental vendor relationships and enhanced benefit programs across assigned markets and products. This position is responsible for establishing and maintaining compliant, efficient, and effective processes that support contractual requirements, regulatory obligations, operational standards, and organizational objectives. The incumbent works collaboratively with internal and external stakeholders to monitor vendor performance, support benefit implementation and administration, address operational issues, and identify opportunities for process improvement.
Essential Functions:- Develop, implement, and maintain processes for oversight of supplemental vendors and enhanced benefit programs in accordance with organizational policies, contractual requirements, and applicable regulatory standards.
- Serve as enterprise subject matter expert for supplemental vendors and enhanced benefit strategy.
- Develop and lead the enterprise strategy for supplemental vendor management and enhanced/value-added Medicaid benefits across all markets.
- Monitor vendor and program performance through established metrics, service levels, audits, reporting, and issue escalation processes.
- Create and implement scalable governance frameworks for vendor oversight and enhanced benefit administration.
- Coordinate with internal departments to support administration and continuous improvement of vendor-supported services and enhanced benefits.
- Secure pricing guardrails, actuarial inputs, and approval-to-negotiate from Finance prior to commencing sourcing or re-negotiation of supplemental / enhanced benefit vendor contracts
- Review and approve forecast, budget, accrual projections for all supplemental / enhanced benefit vendors to minimize unexpected financial variance
- Partner with market and product leadership to design, evaluate, and optimize enhanced benefit offerings that support.
- Support implementation, maintenance, and optimization of enhanced benefit offerings across markets, including processes related to operational readiness, documentation, and ongoing administration.
- Review performance trends, identify operational risks or gaps, and recommend or implement corrective actions, remediation plans, or process changes as appropriate.
- Establish enterprise scorecards and performance management processes for vendors and benefit administrators
- Participate in vendor selection, contract review, renewals, amendments, and related activities in partnership with designated business stakeholders.
- Support contract negotiations, renewals, amendments, and RFP processes.
- Support audit activity, readiness reviews, corrective action plans, and regulatory responses related to delegated and non-delegated vendor functions and enhanced benefit administration.
- Oversee operational administration and performance of enhanced benefits including OTC, nutrition programs, maternal and infant support etc.
- Conduct thorough vendor due diligence, including financial, legal, and operational reviews, and maintain ongoing performance monitoring.
- Ensure benefits are implemented consistently and compliantly across markets 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 opportunities for optimization.
- Ensure vendor operations and enhanced benefits comply with: Federal Medicaid managed care regulations, CMS requirements, State contractual obligations, NCQA standards, Delegation oversight requirements, and Privacy and data security regulations
- Ensure enhanced benefits are accurately documented in state filings, member materials, and operational workflows.
- Lead and develop a high-performing vendor management and enhanced benefits team.
- Build scalable processes, operational infrastructure, and talent capabilities to support enterprise growth.
- Perform any other job related duties as requested.
Education and Experience:- 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 progressive leadership experience in Medicaid managed care, healthcare operations, vendor management, product/benefit strategy, or payer operations required
Competencies, Knowledge and Skills:- Deep knowledge of: Medicaid managed care operations, Enhanced/value-added Medicaid benefits, CMS and state Medicaid regulations, Delegation oversight, Managed care contracting, and 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 with supporting complex vendor portfolios, contract administration, audits, and operational improvement initiatives preferred
Licensure and Certification:- Project Management Professional (PMP) certification preferred
- Certified in Healthcare Compliance (CHC) and/or Certified in Healthcare Privacy Compliance (CHPC) preferred
- Additional certifications related to managed care operations, quality, compliance, or vendor oversight preferred
Working Conditions:- General office environment; may be required to sit or stand for extended periods of time
- Up to 25% (regular) travel to attend meetings, trainings, and conferences may be required
Compensation Range:
$135,600.00 - $237,400.00
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
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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