Your career starts now. We are in search of passionate individuals to become the next generation of health care leaders.
At AmeriHealth Caritas, we are dedicated to assisting individuals in accessing care, maintaining well-being, and fostering healthy communities. As a national leader in health care solutions, we provide our associates with opportunities to make a significant impact on the lives of millions through our vast array of products, services, and award-winning programs. Join us in our mission to create healthier communities.
AmeriHealth Caritas, headquartered in Newtown Square, brings over 30 years of experience as a mission-driven organization. We offer comprehensive, outcomes-focused care to those who need it the most, with integrated managed care offerings, pharmaceutical benefit management, specialty pharmacy services, behavioral health services, and other administrative services.
Key Responsibilities: - Serve as the second in command to the Market President, offering strategic leadership.
- Oversee internal operational functions and corporate support systems for essential plan requirements, including claims processing and encounter data submissions/corrections.
- Facilitate regular operational meetings, coordinating with peers from various departments such as Provider Network Management, Compliance, Community Outreach, Contract Management, and IT.
- Ensure compliance with state program contractual and regulatory standards, addressing benefit rules, payment specifications, and performance requirements.
- Act as a key liaison among the state, health plan, and enterprise functions.
- Accountable for fulfilling all contractual obligations and ensuring that both local and corporate teams deliver on commitments.
- Monitor service levels across all functional areas and implement corrective actions when necessary.
- Manage the submission of essential information to corporate for contract configuration to ensure accurate claim payments.
- Maintain up-to-date Policies and Procedures for all local functions in line with regulatory requirements.
- Track State Bulletins to understand operational implications and rally resources for required system and process adaptations.
- Collaborate with the Regional CFO and CMO to execute and track cost containment initiatives.
- Identify potential risks impacting the Plans' strategic and financial goals and develop mitigation strategies.
Education and Experience Requirements: - Bachelor's Degree or equivalent combination of education and experience is required.
- 5 to 10 years of progressive managerial or leadership experience in a Managed Care Organization is preferred.
- Strong understanding of Medicare/Medicaid operations and benefits administration is necessary.
Diversity, Equity, and Inclusion: At AmeriHealth Caritas, we prioritize creating an equitable environment where everyone feels valued and supported. Our commitment to diversity ensures that all associates have an equal opportunity to reach their full potential. We act with integrity and respect while celebrating the diverse perspectives that enhance our workforce, enabling us to better support the communities we serve.
Comprehensive Benefits Package: We offer flexible work solutions, competitive pay, generous paid time off, health insurance coverage from Day 1, a 401(k) plan, tuition reimbursement, and more.