Vice President Plan Operations

1 week ago

Southfield, United States AmeriHealth Caritas Full time

Responsibilities :Ensure compliance with state program contractual and regulatory requirements, including benefit/payment rules, data submissions, and service-level standards.Collaborate with shared services to resolve operational issues through root cause analysis and timely implementation of solutions.Monitor performance metrics and process improvements, serving as liaison between the health plan and enterprise functions.Partner with Service Operations on major changes and enterprise initiatives.Lead cross-functional meetings to foster alignment and coordination across plan and shared services.Develop action plans for operational efficiency and cost containment in partnership with Finance and Clinical leadership.Assess and mitigate plan-specific risks in collaboration with the Enterprise Risk Management team.Provide strategic leadership and oversight for teams managing Provider Network Operations, Community Engagement & Outreach, and Data & Technical Services, ensuring alignment with organizational goals and operational excellence.Education & Experience:A bachelor’s degree is required.Minimum 5 years of experience in Medicaid/Medicare operations with progressive leadership responsibilities10 plus years of progressive experience in business, government, or healthcare management.Deep understanding of Medicaid/Medicare operations and benefit administration.Proven ability to navigate complex, matrixed organizations.

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