Role Overview
Reporting to the EVP & Chief Medical Officer, the SVP Quality, Health Equity and Risk Adjustment will be broadly responsible for the AmeriHealth Caritas Family of Companies’ (ACFC) Quality and Health Equity Programs, inclusive of performance improvement, across all lines of business and in all geographies and Risk adjustment performance. The role will ensure that the AmeriHealth Family of Companies Health Plans’ executes NCQA, CMS and/or ACA Qualified Health Plan related certification requirements in all of its components: Assurance of compliance to quality, health equity, NCQA, continuity & coordination of medical and social care standards and best practices; policies and processes in place which ensure standards are met; measurement and monitoring of quality performance; and performance improvement structures in place. The role will also be responsible for the oversight and governance of Quality Operations include HEDIS report production vendor management, and will ensure analytics needed to support the quality program are in place, whether sourced within the quality organization or working in strong collaboration with other enterprise analytics functional area.
Work Arrangement
- Remote role
- Monday through Friday, 8:00 AM EST to 5:00 PM EST
Travel to corporate campus in Newtown Square, PA based on business needs
Responsibilities
- Quality Structure, Program and Operations for Enterprise, Lines of Business & Medicaid Market
- Health Plans Ratings, Quality & Health Equity Accreditation
- Health Equity
- Risk Adjustment
- Performance Improvement
- HEDIS Quality Performance Reporting, Strategy & Production
- Enterprise Quality and Health Equity Accreditation
- Clinical and Quality Storytelling
- New Business Development
- Technology Enablement
Education and Experience
- Master’s or Doctorate degree required. Degree demonstrating healthcare and/or technical background and skills highly desirable
- Managed Care Quality Leadership
- Minimum of 10 years of experience in a multi-state multi-product health plan organization
- Healthcare Leadership/Management
- Quality Initiative Development;
- Medicaid/Medicare/ACA Managed Care experience
- Health Plan Quality & HEDIS experience
- Experience with NCQA and HEDIS vendors
- Experience with health plan technology applications
- Experience with data management approaches
Skills and Abilities
- Ability to manage multiple large-scale projects simultaneously
- Ability to influence senior level executives
- Strong business acumen and financial skills
Exceptional communication skills and the ability to make complex concepts simple and easy to understand
Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 40 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
We are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs.
Our Comprehensive Benefits Package
Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k), Tuition reimbursement, and more.