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.