Director Corporate Medicare STARS Quality Improvement
Financial Services - Insurance
1103 Market St
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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 Philadelphia, 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.
This position will provide leadership and oversight of Quality Improvement activities and strategic plans for all levels of the AmeriHealth Caritas Medicare organization, including Medicare Medicaid Plans. This position will lead a number of task forces and subgroups and oversee data collection and implementation of quality improvement projects working with business leaders in compliance, customer service, enrollment, finance, grievance and appeals, medical economics, medical management, operations, provider network relations, quality and vendor relations and management. This cross-functional role will be accountable to providing the direction needed for Stars and quality incentive bonus program improvement and aligning the accountable parties to ensure a comprehensive understanding and visibility into risks and timely introduction of measures to address improving performance.
Works directly with Senior Executives to plan, organize and direct the identification, prioritization and implementation of strategic projects that improve financial, service and clinical outcomes for the Plan, LOB or Product Line.
In coordination with Plan stakeholders, develop, implement and lead strategy to improve HEDIS and Stars outcomes and maximize pay for performance payout.
Provides functional support to the Network Management, Informatics, Information Solutions, Care Coordination, Utilization Management, and Public Affairs departments to integrate Quality Management initiatives and goals with organizational programs.
Plays an active role in the dissemination of the Quality Management best practices throughout the AmeriHealth Caritas Family of Companies and assists with new business opportunities and implementation.
Provides leadership through both direct and indirect matrixes reporting structures.
Manager, mentor and resource for Medicare Quality Directors/managers
Bachelor s Degree.
Master s Degree preferred.
This is a senior level position and requires a comprehensive quality improvement background in Medicare Advantage.
8 10 years of progressive management experience (including staff management) in a managed care environment.
Health care quality certification (i.e. ABQAURP or CPHQ) preferred
Experience supporting multiple health plans, preferably at the regional or corporate level.
RN or Health Care quality certification preferred.
Ability to travel to other plans often without notice.
Proven ability to navigate effectively and influence at the executive level in a matrixed, multi-business enterprise.
Demonstrated ability to interface, influence and made strategic and tactical decisions at the executive management level.
Strong background in managed care information systems, data collection and reporting.
High degree of operational and clinical expertise and knowledge of various managed care payment arrangements.