Director, Enrollment Operations – Duals Special Needs Enrollment Experience Required

CareSource

. Lead end-to-end enrollment operations across markets, including prospective enrollment, auto-enrollment, disenrollment, and reinstatement .

Posted 9/22/2026full-timeRemote • United StatesLead💰 $113,000 - $197,700 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in leading enrollment operations, including system integration, compliance with CMS and Medicaid regulations, and operational transformation initiatives. Proven ability to develop and execute enrollment strategies while managing vendor relationships and overseeing operational metrics.

Highest-signal resume keywords

Enrollment Operations LeadershipCMS Compliance ManagementHealthcare System IntegrationData Governance and ReconciliationOperational Transformation Initiatives

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Enrollment OperationsData MigrationProcess StandardizationKPI MonitoringFinancial ReconciliationAudit ReadinessEnrollment Policy DevelopmentOperational WorkflowsSystem IntegrationRegulatory Compliance

Soft Skills

Analytical SkillsProblem-Solving SkillsInterpersonal CommunicationTeam DevelopmentChange Management

Tools & Technologies

TriZetto EAMFacetsMARxHPMSMMISMicrosoft Office

Industry Keywords

Medicaid Managed CareMedicare AdvantageDual Special Needs Plan (D-SNP)Healthcare ManagementRegulatory Frameworks

About the role

Key responsibilities & impact

Lead end-to-end enrollment operations across markets, including prospective enrollment, auto-enrollment, disenrollment, and reinstatement
Lead enrollment operations integration for newly acquired or merging health plans, including system alignment, data migration, and process standardization
Establish and lead an enterprise enrollment oversight framework with reconciliation methodologies, cross-system validation, and executive reporting
Establish and execute enrollment operations strategy aligned with product growth, regulatory requirements, and market expansion
Partner with IT on system enhancements, data governance, and integration strategies
Manage vendor relationships and enrollment partners, ensuring SLA performance and resolving 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 enrollment operations teams
Oversee enrollment, regulatory compliance, financial, and vendor reconciliation activities
Ensure compliance with CMS, Medicaid, and state regulations through audit readiness, audit responses, legislative monitoring, and corrective action plans
Manage CMS 834/820 transactions, state data feeds, and reconciliation processes
Establish and enforce enrollment policies, procedures, and internal controls
Perform other job-related duties as requested

Requirements

What you’ll need

Bachelor's degree in accounting, finance, healthcare management or related field required
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, preferably in a health care environment, required
Medicaid managed care, Medicare Advantage, Dual Special Needs Plan (D-SNP), or related healthcare experience required
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
Ability to travel as required by the needs of the business

Benefits

Comp & perks

Bonus tied to company and individual performance may be available
Comprehensive total rewards package
Employee total well-being support