Medical Affairs Operations Manager

CareSource Management Group Company

Job Overview

Location

Remote

Job Type

Full-time

Full Job Description

📋 Description

• The Medical Affairs Operations Manager serves as a central operational hub for the Medical Affairs team at CareSource Management Group Company, driving standardization, data management, and workflow optimization to support strategic initiatives and improve healthcare delivery efficiency. This role is critical in aligning operational processes with organizational goals, particularly in areas such as prior authorization, clinical policy, quality of care, and affordability initiatives.
• Day-to-day responsibilities include partnering with Medical Affairs leaders to enhance productivity and ensure alignment with company objectives; overseeing long-term tracking and trending of high-priority items like automated prior authorization processes and market reviews related to utilization and cost; managing and reporting on productivity and performance metrics, including MD and vendor auditing; developing standardized reporting across teams for senior leadership updates; investigating and analyzing issues identified by leaders through data, focusing on state complaints and concerns; supporting KPI reviews for potential Quality and Affordability Initiative (QAI) projects; tracking project timelines and maintaining a comprehensive project tracker; facilitating multidisciplinary and cross-departmental collaboration for project management and QAI development; leading optimization initiatives involving AI applications, workflow enhancements, automated documentation, and standardized data reporting; leading routine meetings to ensure project alignment and progress; developing tools to improve efficiency and automate manual tasks; creating centralized educational sessions for front-line clinical teams; gathering information for vendor RFPs; representing Medical Affairs in new business initiative implementations; and performing other job-related duties as requested.
• The Medical Affairs team at CareSource operates within a mission-driven healthcare organization dedicated to improving access, affordability, and quality of care for members. This role collaborates closely with clinical, operational, and analytical teams to ensure that Medical Affairs functions are efficient, data-informed, and aligned with broader organizational strategies in a remote-first environment.
• In this role, the individual will develop advanced expertise in healthcare operations, data-driven process improvement, and project management within a complex healthcare system. They will gain experience in leading cross-functional initiatives, leveraging AI and automation for operational efficiency, and influencing clinical and administrative decision-making through data analysis and reporting—positioning them for growth into senior operational or strategic leadership roles within healthcare management.

🎯 Requirements

• Bachelor's degree in healthcare administration, nursing, or a related field required; Master's degree preferred
• Five (5) years of project management experience in a healthcare setting required
• Current unrestricted license as a Registered Nurse (RN) or Nurse Practitioner (NP) required
• MCG certification required or must be obtained within 6 months of hire
• Skilled in project management, data analysis, and operational workflow optimization; proficient in project management tools and data reporting software
• Strong analytical skills with ability to interpret complex data and identify trends; excellent communication and interpersonal skills

🏖️ Benefits

• Competitive salary range of $83,000.00 - $132,800.00 based on education, training, experience, and role scope
• Eligibility for performance-based bonus tied to company and individual performance
• Comprehensive total rewards package supporting employee total well-being
• Remote work flexibility with up to 15% occasional travel based on department needs
• Opportunities for professional development including preferred Project Management, Six Sigma, or other process improvement certifications

Skills & Technologies

Remote

Degree Required

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CareSource Management Group Company

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About CareSource Management Group Company

CareSource is a nonprofit, multi-state managed care organization headquartered in Dayton, Ohio. Founded in 1989, it administers Medicaid, Medicare Advantage, and Marketplace health plans serving over two million members in Ohio, Kentucky, Indiana, West Virginia, and Georgia. The company focuses on improving health outcomes for low-income and vulnerable populations through integrated care management, behavioral health services, and social determinants programs.

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