Director, Member Experience (Process Improvement)

Accountabilities: Develop, implement, and monitor enterprise strategies designed to improve member satisfaction, engagement, retention, and growth across Medicaid lines of business, with potential application to Medicare and Marketplace programs.

Identify and drive process improvements that enhance the end-to-end member and provider experience, addressing pain points across areas such as pharmacy, provider relations, networks, and other critical touchpoints.

Partner with health plan and executive leadership to identify, prioritize, and implement initiatives that support membership retention and align with strategic objectives.

Establish and regularly review performance scorecards, reports, and key metrics to assess progress, identify risks, and recommend actions to improve results.

Monitor member satisfaction and retention activities against state and organizational objectives, developing and implementing corrective strategies when performance requires course correction.

Collaborate extensively across departments to ensure policies, programs, processes, and strategic initiatives contribute effectively to membership retention targets.

Identify technology and operational support requirements and drive their successful implementation to strengthen member satisfaction and retention programs.

Participate in enterprise health plan meetings and contribute to broader strategic planning and business decisions.

Build strong relationships with internal stakeholders, members, providers, clients, and other partners to facilitate collaboration and achieve measurable improvements.

Use process improvement methodologies, including Six Sigma principles, to identify inefficiencies, optimize workflows, and establish sustainable improvements.

Requirements:

Bachelor’s degree in a health-related discipline or equivalent professional experience.

At least 7 years of experience in Medicaid Managed Care, particularly within sales, outreach, member engagement, or related functions.

At least 3 years of management or supervisory experience, with a demonstrated ability to lead teams and influence cross-functional initiatives.

Strong expertise in process improvement, including Six Sigma methodologies and the ability to translate operational challenges into scalable solutions.

Thorough understanding of Medicaid product lines and applicable state, federal, and third-party regulatory requirements.

Proven ability to influence and persuade senior-level leaders on matters of significant organizational importance and contribute to policy development.

Exceptional networking, negotiation, communication, public speaking, and presentation skills.

Ability to work independently with limited supervision while collaborating effectively in a fast-paced, team-oriented environment.

Strong strategic thinking and problem-solving skills, with a track record of turning member or customer experience challenges into actionable initiatives.

Ability to establish and maintain productive relationships with colleagues, clients, members, providers, customers, and other stakeholders.

Healthcare or pharmacy experience is highly preferred.

An active State Life and Health and/or Disability License without infraction is preferred.

Benefits:

Competitive annual compensation ranging from $96,325.57 to $208,705.40 , depending on geographic location, experience, education, and skill level.

Full-time, fully remote work arrangement within the United States.

Competitive benefits and compensation package.

Opportunity to influence enterprise-wide member experience, retention, and process improvement strategies.

High-visibility leadership role with extensive cross-functional and executive-level collaboration.

Opportunity to contribute to initiatives spanning Medicaid and potentially other healthcare lines of business.

Equal employment opportunity environment.

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