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Chief Quality Officer

2 months ago

New York, New York, United States AmeriHealth Caritas Full time
Position Overview:
AmeriHealth Caritas is on the lookout for a dedicated and skilled Chief Quality Officer to spearhead our Quality and Health Equity initiatives.


The successful candidate will possess over a decade of experience in Managed Care Quality leadership, focusing on quality enhancement strategies and achieving superior health outcomes across a diverse range of health plan products including Medicaid and Medicare.

About AmeriHealth Caritas:
Based in Newtown Square, AmeriHealth Caritas has a rich history of over 40 years in delivering comprehensive, outcome-focused care to underserved populations. We provide a wide array of integrated managed care solutions, including pharmaceutical benefits, specialty pharmacy services, behavioral health support, and various administrative services.

Our mission is to empower individuals to access care, maintain wellness, and foster healthy communities. As a leader in healthcare solutions, we offer our team members the chance to make a significant impact on the lives of millions through our extensive range of products and award-winning programs.

Key Responsibilities:
In this pivotal role, you will report directly to the Executive Vice President & Chief Medical Officer.

Your primary responsibilities will include overseeing the Quality and Health Equity Programs for the AmeriHealth Caritas Family of Companies (ACFC), which encompasses Medicaid, Medicare, and Exchange lines of business across various regions.


You will be tasked with directing enterprise-wide quality strategies, performance enhancement initiatives, and operational frameworks that drive industry-leading health plan ratings and outcomes.

Specific Duties Include:
  • Ensuring compliance with NCQA, CMS, and ACA Qualified Health Plan certification requirements.
  • Establishing policies and processes to meet quality standards, alongside monitoring and measuring quality performance.
  • Overseeing Quality Operations, including HEDIS report generation and vendor management.
  • Collaborating with analytics teams to ensure robust support for quality programs.
Opportunities for Impact:


As Chief Quality Officer, you will have the chance to:

  • Design and implement a comprehensive quality strategy and operational model across the organization.
  • Achieve and maintain 4-star ratings or higher for all lines of business.
  • Promote health equity by integrating it into all quality initiatives.
  • Manage the HEDIS production process and liaise with the HEDIS Oversight Auditor.
  • Lead the accreditation strategy for the enterprise.
  • Direct the clinical informatics strategy related to HEDIS.
Qualifications:
The ideal candidate will possess:
  • A minimum of 10 years of experience leading quality strategy and operations in a multi-state, multi-product Managed Care environment with a proven track record of achieving high ratings.
  • Extensive leadership experience that demonstrates strong business acumen and financial expertise.
  • In-depth knowledge of Health Plan Quality, including familiarity with NCQA and HEDIS processes.
  • Experience in Population Health within a Healthcare Delivery System or Health Plan is preferred.
  • A Master's degree in a relevant healthcare field is required.
Diversity, Equity, and Inclusion:
At AmeriHealth Caritas, we value diversity and strive to create an inclusive environment where all associates feel respected and empowered to reach their full potential. We are committed to equity and actively work to dismantle barriers to foster a more inclusive workplace.

Our diverse workforce enhances our ability to serve the communities we support, making our organization more innovative and vibrant.

Benefits:
We offer a comprehensive benefits package that includes:
  • Flexible work arrangements, including remote and hybrid options.
  • Competitive compensation.
  • Generous paid time off, including holidays and volunteer opportunities.
  • Health insurance coverage effective from Day 1 for you and your dependents.
  • 401(k) plan.
  • Tuition reimbursement and additional benefits.