CareSource · 6 hours ago
Sr. Director, Quality & Population Health(Must Live In Indiana)
Indianapolis, IN
Full-time
Onsite
Mid, Senior Level
$136K/yr - $237K/yr
5+ years expCareSource is a healthcare organization focused on improving quality and population health. The Senior Director, Quality Improvement and Population Health is responsible for executing strategies to achieve quality goals and outcomes, collaborating with stakeholders, and ensuring compliance with regulatory requirements.
Health CareMedicalNon Profit
Responsibilities
Execute Quality Strategy and Population Health Strategy to achieve goals and outcomes for product or market
Lead and collaborate with internal and external stakeholders to drive quality initiatives. Effectively represent CareSource with regulators and auditors to ensure continuous contract compliance as well as demonstrable innovation in quality program administration. Oversee population health management documentation and timely submission
Ensure effective application of population health management model is conducted through the lens of health equity, including rigorous approach to population assessment, program measurement and evaluation
Assist in determination of benchmarks, goals and outcomes for defined programs, informed by analytics and evidenced based practice
Serve as key liaison to state and/or federal health care program agencies regarding quality improvement and population health activities
Participate in national health standards committees and focus groups specific to specialty programming and interventions, providing input on behalf of CareSource
Provide oversight of programmatic and interventional activities in accordance with contractual, regulatory requirements and NCQA standards
Support care management programs as necessary utilizing NCQA standards to sustain accreditation if applicable
Monitor compliance within product and/or market to promote standardization while ensuring compliance with provider agreement requirements
Collaborate with Physician Relations, Medical Director, Community Marketing and Corporate/BPG to deliver market outcomes
Develop and sustain community service agency relationships and provide general quality oversight for contracted community partner services
Ensure quality requirements are met through continual review, audit and monitoring of quality improvement/performance improvement activities, including case management quality, HEDIS and STARS performance
Co-Chair Ohio Quality Improvement Committee. Provide leadership support for Population Health and Health Equity workgroups
Direct, participate and drive the prioritization of product/program projects ensuring alignment with organization wide initiatives
Work closely with the information technology (IT) to ensure innovative technological advancements, including clinical and health risk assessments care planning, reporting, trending, tools, etc. are used daily to improve member care, quality and outcomes
Work closely with the Provider Relations team to ensure that the product/ programs have specialized network expertise which utilizes appropriate clinical practice guidelines and protocols
Collaborate with Enterprise team to identify, deliver and oversee relevant education and training
Collaborate with CareSource Internal Audit and Regulatory Departments in ensuring compliance with all regulatory requirements
Ensure compliance with the MOC and oversee model of care for product
Ensure compliance with all statutes and regulations for product
Develop and maintain an in-depth knowledge of the company’s business and regulatory environments
Direct, manage, and oversee the work of the market quality / operations team
Maintain, develop and implement care management policies, procedures, goals and utilization protocols; design and improve the product to improve the quality of care and lower total cost of care for members
Review and provide input to the member benefit package at designated intervals
Perform any other job duties as requested
Qualification
Required
Bachelor's Degree in health care field or equivalent years of relevant work experience is required
Minimum of five (5) years of healthcare, healthcare operations and/or managed care experience with managed care performance metrics and HMO concepts is required
Minimum of five (5) years of experience in case management, disease management, medical management, and/or quality improvement required
Minimum of five (5) years of leadership/management experience is required
Current, unrestricted license as a Registered Nurse (RN) in state of practice is required or Certified Professional in Health Care Quality (CPHQ) by the National Association for Healthcare Quality (NAHQ), Certified Quality Improvement Associate (CQIA) by the American Society for Quality (ASQ), and/or Certified in Health Care Quality Management (CHCQM) by the American Board of Quality Assurance and Utilization Review Providers (ABQAURP) within six (6) months of employment is required
Proficient in Microsoft Excel, Word, PowerPoint and Excel
Knowledge of regulatory reporting and compliance requirements both Medicaid and Medicare
Knowledge of managed care industry and its trends
Knowledge of clinical guidelines (Milliman, InterQual)
Advanced knowledge of HEDIS and STAR performance metrics
Critical listening and systematic thinking skills
Ability to maintain confidentiality and act in the company's best interest
Strong oral, written, and interpersonal communication skills
Excellent leadership, management and supervisory skills and experience
Energetic, enthusiastic, and politically astute
Ability to act with diplomacy and sensitivity to cultural diversity
Responsive to a changing environment
Strategic management skills
Conflict resolution skills
Planning, problem identification and resolution skills
Business process/management skills
Preferred
Master's degree in health-related field is preferred
Three to five (3-5) years of Government program experience is preferred
Benefits
You may qualify for a bonus tied to company and individual performance.
A substantial and comprehensive total rewards package.
Company
CareSource
CareSource provides managed care services to Medicaid beneficiaries.
1001-5000 employees
Funding
Current Stage
Late StageTotal Funding
unknownKey Investors
FHLB Cincinnati
2026-01-17Grant
Leadership Team
Erhardt Preitauer
President & Chief Executive Officer
Jason Bearden
Market President and CEO, Georgia
Recent News
2026-01-18
Dayton Daily News
2025-12-17
Company data provided by crunchbase