Vice President Plan Operations & Administration

Job Summary

The VP Plan Ops and Admin is responsible for leading the Plan Operations for the North Carolina Medicaid plans. This role will support the Market President in executing the enterprise strategic plan at the local level by driving market strategic initiatives that align to contractual requirement, priorities and stakeholder needs. This role serves as a second in command to the Market President, ensuring all components of the North Carolina plan infrastructure are operating effectively and efficiently and that all service levels are met by coordinating across shared service functional areas to ensure that the enterprise strategy is executed within the regulatory requirements of the Plans.

Work Arrangement:  This position with hybrid with frequent travel within the state.  Will attend state and provider meetings. 

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 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 and issue resolution.
• Monitor results and develop action plans for operational and cost containment initiatives, in collaboration with the Plan Finance Director and Market CMO.
• 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 lead for the Delegation Oversight Committee of our parent company; coordinate across enterprise shared services to provide comprehensive updates in accordance with the Committee’s monthly and quarterly meeting schedule.
• Serve as day-to-day leader for the Provider Network Operations, Community Engagement & Outreach, Regulatory, and Data & Technical Services teams, with leadership responsibility for over 100 associates.

Education/Experience:

• Bachelor’s Degree required. 
• Preferred Experience: previous experience in a health plan leadership role.
• 5 or more years operational experience in Medicaid/Medicare.
• 10 or more year progressive responsibility in Business, Government, or Health Care Management experience.
• In-depth understanding of Medicaid/Medicare operations and benefit administration.
• Proven experience in navigating relationships in a matrixed organization.

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.

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.

Discover more about us at www.amerihealthcaritas.com.