AVP, Integrated Care Management Operations(Preferred Experience In Managed Care & DUALS/FIDE)

Job Summary:

The Associate Vice President, Integrated Care Management Operations - MA collaborates closely with both Market and Corporate Leadership to ensure the effective delivery of integrated care services across multiple high-volume membership markets and/or markets serving complex populations. This role is instrumental in aligning local service operations with organizational goals, enhancing care quality, improving member outcomes, advancing health equity, and ensuring compliance with state, federal, and accreditation requirements. The Associate Vice President, Integrated Care provides strategic leadership, operational oversight, and program direction for integrated care and care management activities across assigned regions. In partnership with Market Leadership, Medical Directors, Quality, Analytics, and other key stakeholders, this leader develops and implements innovative, evidence-based programs, standardized operating models, and scalable processes that support exceptional member experiences, quality outcomes, regulatory compliance, and financial performance. The role also fosters strong relationships with community organizations, healthcare providers, and external partners while supporting growth initiatives, new business implementation, and continuous improvement efforts.

Essential Functions:

• Accountable for collaborating with Market and Corporate Leadership to support the strategy and operations of dual product care management within multiple high-volume and/or complex population markets and to ensure alignment with organizational business programs, priorities, and processes.
• Provide strategic direction, leadership, and oversight for integrated care activities across the continuum of care, ensuring effective coordination and management of member needs.
• Ensure programs, operational processes, and care management models within regional markets are appropriately developed, standardized, scalable, and aligned with the corporate Integrated Care framework.
• Lead the development, implementation, and evaluation of integrated care programs, innovations, and evidence-based practices designed to improve member outcomes, member experience, quality performance, and operational effectiveness.
• Establish strategic, operational, and financial plans that optimize the effectiveness and efficiency of integrated care operations while supporting organizational growth and market-specific needs.
• Assign appropriate priorities according to organizational goals, business plans, regulatory requirements, and market performance objectives.
• Lead, implement, develop, and support programs, systems, technologies, and processes that ensure consistent, effective, and efficient delivery of integrated care services while meeting state regulations and market financial objectives.
• Partner with Market Leadership, Quality, Analytics, Medical Affairs, and other operational leaders to develop performance targets, evaluate outcomes, identify trends, and implement timely corrective actions.
• Review financial, utilization, quality, service, and operational reports to identify opportunities, analyze trends, and drive data-informed decisions that improve performance and member outcomes.
• Develop, maintain, and continuously refine integrated care staffing models, resource allocation strategies, and organizational structures to support market variability, operational efficiency, and sustainable growth.
• Support the standardization of integrated care processes, workflows, operational content, and best practices to improve consistency, scalability, and continuous process improvement across markets.
• Collaborate with organizational leaders to ensure successful integration of innovation, technology, and data-driven solutions that enhance member support, address social determinants of health, and advance health equity initiatives.
• Monitor continuous quality improvement activities and program effectiveness in accordance with regulatory requirements, URAC, NCQA, HEDIS, accreditation standards, and evolving business needs.
• Develop, implement, and monitor accountability systems, leadership development initiatives, succession planning strategies, and performance improvement frameworks that support organizational excellence.
• Foster strong external and internal relationships with hospitals, physicians, behavioral health providers, community-based organizations, government agencies, vendors, and other key stakeholders.
• Develop, manage, and oversee departmental and program budgets while ensuring responsible stewardship of resources, achievement of performance goals, and return on investment for integrated care initiatives.
• Serve as a liaison, consultant, and organizational representative with regulators, market leadership, executive leadership, and other stakeholders regarding integrated care strategy, performance, and operational initiatives.
• Provide leadership, guidance, and support to direct and indirect leaders to ensure successful execution of organizational goals, operational priorities, regulatory requirements, and strategic initiatives.
• Support new business implementations, market expansions, acquisitions, and organizational transitions by providing integrated care leadership, operational expertise, and implementation oversight.
• Cultivate and promote the organizational culture and mission to improve the health and well-being of members and communities served.
• Perform any other job related duties as requested.

Education and Experience:

• Bachelor's degree in Business, health care or other related field required
• Master's degree preferred
• Equivalent years of relevant work experience may be accepted in lieu of required education
• Ten (10) years of clinical operations leadership and/or case management, disease management, medical management, quality improvement, or related experience required
• Five (5) years of senior level management experience required
• Five (5) years of Managed Care experience in a multi-market organization required
• Experience in a collaborative matrix environment preferred

Competencies, Knowledge and Skills:

• Microsoft Office proficiency
• Clinical data analysis and trending skills
• Knowledge of trends in healthcare, managed care, Medicaid/Medicare, long term-care, case/medical management, and quality improvement
• Strong knowledge of healthcare regulations, quality improvement methodologies, and population health management
• Excellent analytical, problem-solving, and decision-making skills
• Commitment to the mission and values of the CareSource Family of Companies
• Strong oral, written and interpersonal communication skills
• Knowledge of regulatory reporting and compliance requirements
• Excellent leadership skills

Licensure and Certification:

• Case Management or Managed Care certification and Certification in Healthcare Quality preferred
• To help protect our employees, members, and the communities we serve from acquiring communicable diseases, Influenza vaccination is a requirement of this position. CareSource requires annual proof of Influenza vaccination for designated positions during Influenza season (October 1 – March 31) as a condition of continued employment. Employees hired during Influenza season will have thirty (30) days from their hire date to complete the required vaccination and have record of immunization verified.
• CareSource adheres to all federal, state, and local regulations. CareSource provides reasonable accommodations to qualified individuals with disabilities or medical conditions, sincerely held religious beliefs, or as required by state law to enable the employee to perform the essential functions of the position. Request for accommodations will be completed through an interactive review process.

Working Conditions:

• General office environment; may be required to sit or stand for extended periods of time
• Travel is not typically required

Compensation range $150,000-$300,000.  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

• Fostering a Collaborative Workplace Culture

• Cultivate Partnerships

• Develop Self and Others

• Drive Execution

• Energize and Inspire the Organization

• 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.

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