Director, Enrollment Operations(Duals Special Needs Enrollment Experience Required)

CareSource; Dayton (OH); Hybrid; USD 113,000 - 198,000; Full time

Job summary

CareSource in Dayton, Ohio seeks a Director of Enrollment Operations to lead enterprise enrollment activities across product lines. The role oversees end-to-end member enrollment, data integrity, platform integration, vendor coordination, and regulatory compliance with CMS, Medicaid agencies, and MMIS systems.

The position requires strategic thinking, strong leadership, and the ability to drive transformation through automation and process improvements while managing cross-functional teams and

Qualifications

• Bachelor's degree in accounting, finance, healthcare management or related field is required.
• MBA or other related post-graduate degree preferred.
• Minimum 7 years leadership/management experience.
• Minimum 5 years business operations experience in healthcare.

Responsibilities

• Lead end-to-end enrollment operations across markets and lifecycle activities, ensuring accuracy, timeliness, and SLA adherence.
• Oversee integration of enrollment operations for mergers/acquisitions, including data migration and process standardization.
• Establish enterprise enrollment oversight framework with dashboards, reconciliation models, and executive reporting.
• Define enrollment strategy aligned with regulatory requirements and market expansion.
• Collaborate with IT on system enhancements, data governance, and scalable integration.
• Manage vendor relationships and enrollment partners ensuring SLA performance and issue resolution.
• Drive transformation initiatives including automation and AI-enabled reconciliation.
• Monitor KPIs and identify risks, compliance gaps, and improvement opportunities.
• Lead and develop high-performing enrollment operations teams.

Skills

Leadership

Enrollment Operations

Regulatory Knowledge

Data Governance

Strategic Planning

Change Management

Analytical Thinking

Communication

Education

Bachelor's degree in accounting, finance, healthcare management or related field

MBA or related post-graduate degree preferred

Equivalent years of relevant work experience

7 years leadership/management experience

5 years healthcare operations experience

Medicaid/Medicare experience

Tools

CMS/Medicaid platforms (Facets, MARx, HPMS)

TriZetto EAM

MMIS systems

Job description

Job Summary

The Director, Enrollment Operations provides strategic and operational leadership for enterprise enrollment operations across assigned product lines. This role oversees end-to-end member enrollment operations, data integrity, platform integration, vendor coordination, and regulatory compliance across CMS, state Medicaid agencies, internal systems, and external partners.

Essential Functions

• Lead end-to-end enrollment operations across markets, including lifecycle activities (prospective enrollment, auto-enrollment, disenrollment, reinstatement), ensuring accuracy, timeliness, and SLA adherence.
• Lead integration of enrollment operations for newly acquired or merging health plans, including system alignment, data migration, and process standardization.
• Establish and lead an enterprise enrollment oversight framework, including reconciliation methodologies, cross-system validation, and executive reporting to ensure data integrity across internal systems, CMS platforms, and state MMIS systems (e.g., Facets, MARx, HPMS).
• Establish and execute enrollment operations strategy aligned with product line growth, regulatory requirements, and market expansion.
• Partner with IT to define system enhancements, data governance, and integration strategies supporting scalability and compliance.
• Manage vendor relationships and enrollment partners, ensuring SLA performance and timely resolution of enrollment exceptions.
• Drive transformation initiatives, including automation, AI-enabled reconciliation, and process optimization.
• Monitor KPIs and operational metrics to identify risks, compliance gaps, trends, and improvement opportunities.
• Lead, develop, and manage high-performing enrollment operations teams.
• Accountable for enrollment, regulatory compliance, financial, and vendor reconciliation activities across assigned lines of business.
• Ensure compliance with CMS, Medicaid, and state regulations by leading audit readiness, audit responses, legislative monitoring, and corrective action plans.
• Manage CMS 834/820 transactions, state data feeds, and reconciliation processes to ensure accuracy and timeliness.
• Establish and enforce enrollment policies, procedures, and internal controls.
• Perform any other job related duties as requested.

Education and Experience

• Bachelor's degree in accounting, finance, healthcare management or related field required
• Master of Business Administration (MBA) or other related post-graduate degree preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Seven (7) years of leadership and management experience required
• Five (5) years of business operations or similar experience is, preferably in a health care environment, required
• Medicaid managed care, Medicare Advantage, Dual Special Needs Plan (D‑SNP), or related healthcare experience required

Competencies, Knowledge and Skills

• Demonstrated experience leading system integrations, mergers, or operational transformations
• Deep knowledge of enrollment operations, CMS regulations, Medicaid processes, and healthcare operational workflows
• Proven ability to design and operationalize enterprise oversight frameworks, including dashboards and reconciliation models
• Familiarity with healthcare systems such as TriZetto EAM, Facets, MARx, HPMS, and MMIS platforms
• Strong knowledge of compliance, audit, and regulatory frameworks, including internal and external controls
• Ability to develop long-term enrollment strategy and execute near-term initiatives
• Strong analytical and problem-solving skills with the ability to manage competing priorities and timelines
• Demonstrated leadership capability, including team development, engagement, and performance management
• Ability to effectively interact with all levels of management
• Advanced computer skills, including Microsoft Office; ability to learn new technologies quickly
• Strong interpersonal, written, and verbal communication skills, including change management capabilities
• General understanding of IT environments preferred

Licensure and Certification

None

Working Conditions

General office environment; may be required to sit or stand for extended periods of time Ability to travel as required by the needs of the business.

Compensation Range

$113,000.00 - $197,700.00 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.

Compensation Type (hourly/salary)

Salary

Organization Level Competencies Fostering a Collaborative Workplace Culture 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 environment of belonging that welcomes and supports individuals of all backgrounds.

#LI-SW2 Brand=CareSource

CareSource mission is known as our heartbeat. Just as we support our members to be the best version of themselves, our employees are driven by our mission to create a better world for members, stakeholders and providers. We are difference-makers who combine compassionate hearts with our unique business expertise to make every opportunity count. Each claim, each phone call, each consumer‑centric decision is a chance to change the world for one member, and our employees look for ways to do that every day. The challenge is, there is no one right way to be the difference and we’re looking for people like you that will rewrite that definition every day. We do what it takes to form creative solutions that make our community and the world just a little better. Discover what it means to be #UniquelyCareSource.