Strategic Enrollment Operations Director

CareSource; Northern (KY); Hybrid; USD 113,000 - 198,000; Full time

Benefits offered by this job

Bonus potential

Total rewards package

Job summary

CareSource is seeking a Director of Enrollment Operations to provide strategic and operational leadership across enterprise enrollment activities. You will oversee end-to-end member enrollment, data integrity, platform integration, vendor coordination, and regulatory compliance across CMS, state Medicaid agencies, internal systems, and external partners.

The role requires strategic oversight, collaboration with IT for system enhancements, and the ability to drive automation and process

Qualifications

• Bachelor’s degree in accounting, finance, healthcare management or related field is required.
• Seven years of leadership and management experience is required.
• Five years of business operations experience in a healthcare environment is required.
• Medicaid managed care or Medicare Advantage experience is required.
• Equivalent education/experience may be considered in lieu of degree.

Responsibilities

• Oversee end-to-end enrollment operations across markets and lifecycle activities.
• Lead integration for newly acquired or merging health plans and data migration.
• Establish enterprise enrollment oversight with dashboards and reconciliation models.
• Partner with IT to define system enhancements and data governance for scalability.
• Manage vendor relationships and enrollment partners to meet SLAs.
• Drive automation and AI-enabled reconciliation and process optimization.
• Monitor KPIs to identify risks, compliance gaps, and improvement opportunities.
• Develop and manage enrollment operations teams.
• Ensure CMS, Medicaid and state regulation compliance including audit readiness.
• Manage CMS 834/820 transactions and state data feeds.
• Establish enrollment policies, procedures, and internal controls.

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 may be accepted in lieu of required education

Seven years of leadership and management experience

Five years of business operations or similar healthcare experience

Medicaid managed care / Medicare Advantage / D-SNP experience

Tools

TriZetto EAM

Facets

MARx

HPMS

MMIS platforms

Job description

CareSource is seeking a Director of Enrollment Operations to provide strategic and operational leadership across enterprise enrollment activities. You will oversee end-to-end member enrollment, data integrity, platform integration, vendor coordination, and regulatory compliance across CMS, state Medicaid agencies, internal systems, and external partners.

The role requires strategic oversight, collaboration with IT for system enhancements, and the ability to drive automation and process