AVP, Market Operations

Job Summary:

The Associate Vice President, Market Operations is responsible for assisting the Market President with market operations administration and providing key strategic compliance, contractual, and financial guidance to support the strategic goals of the market and drive results.

Essential Functions:

• Act as strategic thought partner for the market contractual and financial state driven initiatives and provide guidance on impacts to market and business
• In partnership with e compliance vendor oversight activities and other compliance administration activities as applicable
• Accountability to leadership regarding compliance issues and mitigation activities
• Work with Market President and team to implement new business activities and process improvements throughout the organization in an efficient and effective manner
• Be a strategic thought partner for business owners and finance counterparts focusing on growth efforts and efficiency of processes
• Provide support for proforma work related to RFPs mergers and acquisitions for new business activities including administrative cost projections, staffing models, allocations, and direct market and product costs 
• Support Marketplace and Medicare/DSNP bids including but not limited to staffing models and admin expense impacts
• Perform ad hoc and trending analysis – both proactively and as requested
• Ensure budget policy and procedures are in compliance with Model Audit Rule requirements for Internal Controls Over Financial Reporting including assisting with reporting
• Ensure operational reporting and metrics for compliance are provided to the Market President, senior leadership as necessary
• Ensure direct line leadership and the Market President are informed of all material regulatory initiatives, compliance concerns, operational issues and associated corrective actions/remediation impacting CareSource
• Provide strategic leadership to ensure organizational compliance with federal, state, Centers for Medicare & Medicaid Services (CMS) and applicable regulatory and accreditation requirements
• In Partnership with compliance, oversee regulatory account management teams to ensure that regulatory requirements impacting products are tracked and implemented in a timely manner utilizing compliance processes and forms and ensure that regulatory account management teams work with the business and legal to help ensure proper interpretation and implementation of such laws, regulations, guidance, contracts and similar regulatory requirements (collectively “laws”)
• Establish and maintain a positive working relationship with state and federal regulators as applicable, drive internal functional area accountability for timely and accurate regulatory submissions
• Assist Corporate Compliance to ensure that all elements of an effective compliance program are in place and working effectively
• Assist the risk assessment for the applicable product line and oversee mitigation activities to ensure risks are addressed as appropriate
• Ensure risk assessment is developed in coordination with and consultation with the Enterprise Risk Management team; develop risk assessment reporting utilizing corporate templates and protocols
• Provide support in the oversight of the Compliance corrective action plan (CAP) process, tools and reporting for internally issued CAPS
• Provide support of the organizational participation in regulatory audits and site visits as applicable and coordinate with the external audit team utilizing corporate defined forms and protocols where available and appropriate
• Provide management and strategic direction for compliance program staff for Medicaid, Marketplace and Medicare products as applicable
• Perform any other job duties as requested

Education and Experience:

• Bachelor degree in finance, business, health care or related field, or equivalent work experience is required
• Master’s degree is preferred 
• Minimum of seven (7) years of relevant work experience within health plan operations is required, to include at least five (5) years directly involved in government programs or managed care industry is preferred
• Minimum of five (5) years of progressive leadership experience is required
• Established relationships with the Department of Health & Human Services (HHS), Centers for Medicare & Medicaid Services (CMS), state Departments of Insurance and/ or state Medicaid Departments is preferred

Competencies, Knowledge and Skills:

• Extensive knowledge of health care/managed care regulatory environment
• Strong audit and/or compliance monitoring skills
• Strong strategic leadership/management skills
• Excellent analytic, research and organizational skills
• Proficiency in Microsoft Office including Excel, Word and PowerPoint
• Excellent written and oral communications skills
• Ability to present pertinent data and recommendations clearly and concisely in a manner appropriate to end user audience(s)
• Effective active listening and critical thinking skills
• Excellent time/project management and prioritization skills
• Ability to excel in fluid, matrixed environment
• Ability to influence the organization with or without authority
• Strong Government Program knowledge or related experience

Licensure and Certification:

• None

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time

Compensation range $150,000-$300,000. 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. 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

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Energize and Inspire the Organization

• 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 inclusive environment that welcomes and supports individuals of all backgrounds.