Director, Program Operations
CareCore National 77 reviews - Bluffton, SC

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Grow and build designated CareCore programs by implementing new clients, assisting in sales, and creating new product offerings and enhancements. Maintain programs by managing, supervising, and documenting all program operations. Improve operational performance of programs in terms of efficacy for the client and efficiency for CCN by monitoring reports, workflows, and audits.
  • Implement new client programs – design, evaluate requirements, communicate requirements, and supervise build of program within CareCore’s applications, business processes, and systems
  • Review periodic reports and make operational assessments and recommendations to improve performance and efficiency
  • Identify areas for process and quality improvement and manage process improvement projects
  • Gain an understanding for utilization management, claims operations, CCN IT operations, and CCN call center operations
  • Create and reviews all IT requirements effecting the program
  • Periodically review program payment rules and update appropriate policies and claims engines
  • Monitor and facilitate criteria and CPT code updates
  • Document current and future workflows and requirements for each plan within the program
  • Assess operational risks and recommends mitigating actions
  • Report overall program performance
  • Coordinate with key leaders to execute projects
  • Prepare training and direction to CareCore staff and health plan designees
  • Manage program budget and forecasts
  • Assist sales and marketing team with operations related material and presentations, including RFPs and RFIs from potential clients
  • Supervise team of Associates and Analysts as assigned
  • Bachelors Degree in Business, Mathematics, or similar field of study
  • MBA Preferred
  • 10 years or more of management experience
  • Experience in two or more of the following areas: Project management, call center operations, IT software development management, health services management, data analytics, healthcare economics, and / or management consulting
  • Excellent verbal and written communication skills

About this company
77 reviews
eviCore healthcare (eviCore) is a medical benefits management (MBM) company committed to making a positive impact in healthcare. Our...