Vice President Plan Operations & Admininstration

Job Summary

The VP Plan Ops and Admin is responsible for leading Plan Operations for our Pennsylvania Community HealthChoices (CHC) managed long-term services and supports (MLTSS) Medicaid plan. The CHC program serves adults age 21 and older who are eligible for Medicaid and need LTSS services at a nursing facility level of care (either in the home with HCBS services or in a facility) and includes both Medicaid-only and dual-eligible (Medicare and Medicaid) individuals.

This role supports the CHC KF/ACPA Market President in executing the enterprise strategic plan at the local level by leading market-specific strategic initiatives aligned with contractual requirements, business priorities, and stakeholder needs.

Serving as the Market President's primary deputy, this role ensures the CHC KF/ACPA operational and governance infrastructure is functioning effectively and efficiently. The position is accountable for coordinating across shared service and functional partners to drive execution of enterprise strategy in full compliance with regulatory and contractual requirements. This includes oversight of overall operational performance to ensure plan objectives are achieved, service levels are met, compliance is maintained, and financial performance is optimized.

Work Arrangement: Fully remote role with regular travel required throughout Pennsylvania

Essential Functions:

• Apply deep knowledge of state program contractual and regulatory requirements (benefit and payment rules, data and information submission specifications, performance and service level requirements, etc.), to ensure Plan requirements are met. Coordinate with shared services when issues are identified to perform root n/a cause analysis, develop solutions, and implement solutions in a timely and complete fashion.

• Monitor performance against process improvement measures, serving as the liaison between the health plan and enterprise/shared service functions to drive adherence.

• Partner with Service Operations on Plan issues regarding significant service operations changes, specifically related to APD-DRG, ICD-10 and implementation of enterprise special projects/programs.

• Lead cross functional Plan operational meetings to drive collaboration across Plan and shared services resources to ensure alignment and coordination of Plan activities.

• Develop strategic plans, drive execution, develop action plans/clear milestones and actively monitor results for operational and cost containment initiatives, in collaboration with the Plan Market President, Plan Finance Director, Market CMO, and VP of Service Coordination/Clinical.

• Develop and monitor the Plan specific risk profile and mitigation strategies and proactively identify risks that would impact the Plans ability to meet enterprise and local strategic and financial goals and in collaboration with Enterprise Risk Management, develop strategies to mitigate the risks.

• Serve as the PA CHC lead for the Vista Delegation Oversight Committee and coordinate across enterprise shared services to provide comprehensive updates in accordance with the Committee's monthly and quarterly meeting schedule.

• Accountable for the leadership and development of robust strategic plans, strategy activation, and monitoring of results for teams reporting directly or indirectly into this role: HCBS/LTSS Provider Network Management, HCBS/LTSS Provider Network Operations, Community Engagement & Outreach, Regulatory, and Data & Technical Services teams, with leadership responsibility for over 50 PA CHC associates.

• Effectively and professionally represent the CHC health plan in various stakeholder meetings, including state/CMS regulatory oversight discussions, cross-MCO collaborative workgroups, external vendor discussions, and key provider associations or other CHC program advocacy groups.

• Serves as the accountable executive for local vendor oversight, ensuring vendors delivering operational, clinical, and administrative services meet contractual, regulatory, and performance expectations; partners with enterprise vendor management and functional leaders to drive consistent governance, performance monitoring, issue resolution, and continuous improvement across the vendor lifecycle.

Education/Experience:

• Bachelor's Degree.

• Previous experience in Medicaid leadership role.

• 3 or more years People leadership experience.

• 5 or more years Operational experience in Medicaid / Medicare.

• 10 or more years progressive responsibility in Business, Government, or health care management experience.

Preferred:

• Master's Degree (MHA or MBA).

• Experience in the Managed Care Industry with a focus on supporting Long-Term Services and Supports (LTSS) and/or Medicare duals/D-SNP populations.

• Hands-on experience with various HIPAA/other EDI transaction datasets and data sharing arrangements, including 834, 820, 835, EVV, MDS, and others.

• Advanced data analytics skillset, used to translate operational, clinical, and financial data into actionable insights.

• Advanced knowledge of and proficiency in MS Teams and Teams-integrated applications to drive collaboration, workflow efficiency, and effective communication across cross-functional teams.

• Location in greater Philadelphia metro area.

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.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We're looking for the next generation of health care leaders.

At AmeriHealth Caritas, we're 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. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 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.

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Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.