Manager, Customer Care Medicare Strategy

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:

• None

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

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Fostering a Collaborative Workplace Culture

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Cultivate Partnerships

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Develop Self and Others

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Drive Execution

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Influence Others

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Pursue Personal Excellence

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Understand the Business

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