Clinical Business Strategy Lead

Job Summary:

Clinical Operations – Business Strategy Lead serves a subject matter expert and serves as a liaison between internal clinical partners/designees to capture specific business requirements that must be performed by the Clinical Partner or Vendor and serves as a liaison between the Clinical Partner, Organizational Key Stakeholders and Vendors.

Essential Functions:

• Serve as the strategic partner’s advocate anticipating and resolving problems with the strategic partner.  Utilizes partner feedback to determine and recommend best practices
• Coordinate between CareSource and clinical partners/vendors to maximize on the relationship and prevent escalations.
• Develop and maintain expertise in clinical business processes within assigned areas and recommend innovative enterprise level strategies while addressing market specific nuances
• Within assigned areas, develop issue prevention strategies, develop solutions, and participate in negotiating/implementing the chosen course of action
• Facilitate or serve on enterprise clinical committees on behalf of the strategic partner to address business process related needs
• Lead cross-functional meetings with stakeholders to guide the development of performance metrics feedback and identify opportunities in assigned projects
• Participate in the development of business cases on behalf of the clinical leads.
• Assist in the vendor selection process by participating in the RFI/RFP/RFQ process, developing total cost models, and participating in the assessment process
• Act as a liaison between the clinical leads and vendor throughout the vendor lifecycle
• Participate in joint operating committee meetings, and facilitate monthly operational meetings with business owners and delegated/non-delegated vendors
• Perform any other job duties as requested

Education and Experience:

• Bachelor’s degree in business, health administration, health policy or related discipline or equivalent years of relevant work experience is required
• Minimum of three (3) years of experience in managed care clinical programs is preferred
• Previous leadership experience is preferred
• Experience with Medicaid / Medicare or other government programs with highly regulated requirements is preferred
• Working knowledge of state, NCQA, and/or URAC requirements preferred

Competencies, Knowledge and Skills:

• Advanced proficiency level with Microsoft Office Suite including Outlook, Word, Excel and Power Point
• Strong project management skills with ability to handle multiple projects within time constraints
• Strong interpersonal and verbal/written communication skills with demonstrated ability to influence internal/ external constituents
• Ability to speak and effectively communicate in front of individuals and groups, vendors, and executive leadership
• Ability to interact with all levels of leadership, influence change, adoption of vendor management concepts, and lead cross-functional teams and initiatives
• Ability to manage complex responsibilities and decisions producing long-range outcomes
• Highly motivated individual with the ability to work independently in a fast paced environment with changing priorities
• Proficient in interpreting business, compliance and regulatory requirements

Licensure and Certification:

• None

Working Conditions:

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

Compensation Range:

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):

Organization Level Competencies

• Create an Inclusive Environment

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• 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.