Program Manager, Market Vendor Performance

CareSource is seeking a Program Manager, Market Vendor Performance to coordinate programs supporting member benefits and service delivery. The role manages vendor performance, monitors operational metrics, leads improvement initiatives, supports regulatory compliance, and partners with internal and external stakeholders to improve member outcomes and operational excellence.

Responsibilities:

• 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

Requirements:

• 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
• 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
• Experience using operational metrics, dashboards, and data analysis to drive performance improvements preferred