Job Summary:
The Manager, Customer Care Medicare Strategy leads the execution, measurement, and continuous improvement of Customer Care (Call Center and Grievance & Appeals) initiatives that strengthen the Medicare member experience and performance on Medicare Star Ratings, including MCAHPS and relevant Part C and Part D measures. The Manager translates strategy into operational plans, leads Medicare-focused programs and interventions, and partners across Customer Care and key business areas to ensure initiatives are delivered consistently, compliantly, and with measurable results.
Essential Functions:
- Translate the Customer Care Medicare strategy and multiyear Star Ratings roadmap into actionable plans, milestones, resource needs, and team deliverables.
- Lead implementation of Medicare initiatives designed to improve MCAHPS, member experience, retention, quality outcomes, and Customer Care-influenced Part C and Part D measures.
- Establish project plans, performance targets, operational controls, and reporting routines aligned with CMS requirements and organizational goals.
- Analyze member experience, contact center, complaint, quality, and Star Ratings data to identify trends, performance gaps, risks, and improvement opportunities.
- Lead root cause analysis and corrective actions for underperforming measures and recurring member pain points.
- Partner across Customer Care, Markets, Clinical, Quality, Network, Compliance, Product, Digital, Training, Workforce Management, and other teams to coordinate initiatives and remove execution barriers.
- Develop business requirements, workflows, procedures, readiness plans, communications, and implementation materials to support consistent execution.
- Ensure frontline teams understand required processes and their connection to CTM prevention, retention, MCAHPS, Star Ratings, first-contact resolution, and repeat-contact reduction.
- Use top Medicare contact drivers and member feedback to recommend improvements to service processes, training, knowledge content, self-service, digital tools, and proactive outreach.
- Prepare dashboards, executive updates, and recommendations that communicate progress, outcomes, risks, dependencies, and decisions needed.
- Support regulatory and contractual compliance and maintain effective governance, escalation, documentation, and follow-up processes.
- Represent Customer Care in Medicare strategy, quality, and performance forums and build effective stakeholder relationships.
- Hire, coach, develop, and manage direct reports, including performance, goals, workload prioritization, recognition, and succession planning.
- Perform any other job related duties as requested.
Education and Experience:
- Bachelor's degree in Business, Health Care Administration, or a related field required
- Equivalent years of relevant work experience may be accepted in lieu of required education
- Five (5) years of experience in contact center operations, grievance & appeals operations, managed care, Medicare operations, quality improvement, member experience, or a related environment required
- Two (2) years management or leadership experience, preferably in a health plan, contact center, grievance & appeals, or matrixed operational environment required
- Experience using data to drive root cause analysis, performance improvement, and cross-functional implementation preferred
Competencies, Knowledge and Skills:
- Knowledge of Medicare Advantage, CMS requirements, Star Ratings, MCAHPS, and health plan quality and member experience principles
- Knowledge of contact center operations, performance measures, workforce considerations, quality practices, and service trends
- Strong analytical, trending, root cause analysis, and performance measurement skills
- Strong project and change management skills with the ability to translate strategy into operational execution
- Ability to connect operational activity to member experience, quality, retention, compliance, and efficiency outcomes
- Demonstrated leadership, coaching, delegation, staff development, and performance management skills
- Strong collaboration, facilitation, negotiation, influencing, and conflict-resolution skills
- Exceptional written and verbal communication skills across frontline, operational, and senior leadership audiences
- Strong decision-making, problem-solving, critical thinking, prioritization, and risk-management skills
- Ability to build relationships and deliver results across functions and levels in a fast-paced, matrixed environment
- Strong professionalism, interpersonal skills, active listening, and member-focused service orientation
- Proficient in Microsoft Word, Excel, PowerPoint, and related reporting and collaboration tools
Licensure and Certification:
Working Conditions:
- General office environment; may be required to sit or stand for extended periods of time
- Travel is not typically required
Compensation Range:
$83,000.00 - $132,800.00
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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