Healthcare Leadership Executive
6 days ago
AmeriHealth Caritas is a mission-driven organization with over 30 years of experience delivering 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.
Job Summary
We are seeking a seasoned Healthcare Leadership Executive to spearhead our Population Health strategy, driving innovative solutions to improve healthcare outcomes for millions of people across the nation.
Responsibilities
- In partnership with the Vice President of Medicare Care Management and the Chief Medical Officer, lead multiple lines of business clinical operations supporting Population Health objectives, including Care Management, HRAs, Quality metrics, and Model of Care performance.
- Implement and oversee the creation and performance of DSNP Model of Care, ensuring compliance with State and Federal regulations and NCQA requirements.
- Maintain program execution alignment with enterprise policies and monitor performance metrics, taking proactive steps to address opportunities consistent with these guidelines.
- Collaborate with department managers to develop and deliver ongoing education and training on care management procedures.
- Ensure consistent program implementation and staffing across all responsible lines of business, adhering to enterprise policy.
- Update program descriptions, evaluations, policies, and procedures as needed for Quality Assurance, contributing to reporting and participation in Quality committees.
Requirements
- Bachelor's degree required in Nursing or healthcare-related field; Master's preferred or equivalent work-related experience.
- Clinical license required (RN preferred); LCSW or BH equivalent advanced licensure considered.
- Minimum 5 years progressive management experience in managed care environments, including staff management.
- At least 5 years of experience with Managed Medicare clinical programs, with expertise in case management and utilization management program design and implementation.
- CCM certification desired, with completion within 2 years of hire.
Estimated Salary: $120,000 - $180,000 per annum
About AmeriHealth Caritas
We foster an inclusive environment where everyone feels valued, supported, and comfortable being themselves. Our commitment to equity means providing associates with fair opportunities to achieve their full potential. We stand together against injustice, breaking down barriers to create a more vibrant, innovative workplace that better supports the people and communities we serve.
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