Vice President of Quality Assurance

2 weeks ago

San Francisco, California, United States AmeriHealth Caritas Full time
Position Overview:

AmeriHealth Caritas is in search of a dedicated and skilled Senior Vice President to oversee our Quality and Health Equity division. The successful candidate will possess over a decade of leadership experience in Managed Care Quality, focusing on quality enhancement strategies and achieving superior quality outcomes across a diverse range of health plan products including Medicaid and Medicare.

About AmeriHealth Caritas:

Located in Newtown Square, AmeriHealth Caritas has been a mission-driven entity for over 40 years, committed to delivering comprehensive, outcome-oriented care to underserved populations. Our integrated managed care solutions encompass pharmaceutical benefit management, specialty pharmacy services, behavioral health services, and various administrative functions.

Role 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 all regions.
  • Developing and implementing enterprise-wide quality strategies and operational models aimed at achieving top-tier health plan ratings and outcomes.
  • Ensuring compliance with NCQA, CMS, and ACA Qualified Health Plan certification requirements, including the establishment of policies and processes that meet quality standards.
  • Managing the HEDIS report production process and vendor relationships, ensuring that necessary analytics are in place to support quality initiatives.

Key Qualifications:

The ideal candidate will possess:
  • A minimum of 10 years of experience leading quality strategy and operations within a multi-state, multi-product Medicaid/Medicare/ACA Managed Care environment, achieving ratings of 4 stars or higher.
  • Strong business acumen and financial expertise, with at least 10 years in a leadership role that involved influencing senior executives and managing large-scale projects.
  • Extensive experience in Health Plan Quality, particularly with NCQA and HEDIS vendors, as well as data management methodologies.
  • A Master's degree in a relevant healthcare field.

Diversity, Equity, and Inclusion Commitment:

At AmeriHealth Caritas, we prioritize creating an inclusive environment where all associates feel valued and empowered to reach their full potential. Our commitment to equity drives us to foster a workplace that celebrates diverse perspectives and promotes innovation, ultimately enhancing our ability to serve the communities we support.

Benefits:

We offer a comprehensive benefits package that includes flexible work arrangements, competitive compensation, health insurance coverage from day one, 401(k) plans, tuition reimbursement, and generous paid time off.

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