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. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
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