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: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. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. 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
This job description is not all inclusive. CareSource reserves the right to amend this job description at any time.#LI-SW2
Brand=CareSource
