Job Responsibilities

The Director Operations (Healthy DC Plan) reports to the Market President, with oversight of operation services delivered by the  Healthy DC Plan line of business, ensuring that services are aligned and compliant with AmeriHealth Caritas’s Enterprise Business Plan and all relevant federal, state, and local regulatory requirements.

The Director Operations Healthy DC Plan is accountable for ensuring the plan’s operating and financial metrics consistently meet and/or exceed all compliance requirements, key performance targets, and associated service level agreements for all Operational Areas including: Claims, Configuration Information Management, Enrollment, Contact Center Operations, IT, Provider Configuration Management, Program Integrity, Risk Adjustment, Provider Resolution Team, Provider Appeal and Grievances, Member Appeals and Grievances, Network adequacy and others as needed.

Work Arrangement

This is a hybrid position located in our D.C. office at 1201 Maine SW.   Will be required to work in the office 4 days / week. 

Essential Functions

• Works collaboratively with company operations, functional areas, other lines of business, and external vendors to identify opportunities for process improvement to drive compliance and efficiency.
• Develops and implements performance metrics that enables measurement of our progress toward financial sustainability and identify opportunities for improved profitability, health outcomes, and risk adjustment goals; directs analytical activities to identify trends and potential opportunities for root cause analysis; develops strategies and tactics, in partnership with health plan service operations to mitigate any performance issues/risks to ensure established service levels are met (e.g., claims accuracy, grievance & appeal timeliness.
• Proactively develops, tracks, and reports performance relative to compliance requirements, key performance targets and/or associated service level agreements to Market President.
• Partners closely with Compliance and Internal Audit to identify risk areas and ensure appropriate oversight and closure of internal and external corrective action plans.
• Participates in the planning, developing, and implementing Health Plan activities related to the HEDIS process, improving HEDIS rates and member satisfaction.
• Other duties as assigned.

Education/Experience:

• Bachelor’s Degree (Required).
• Demonstrated adaptability and flexibility to a rapidly moving business environment.
• Process improvement and project management experience.
• Well-developed analytic experience.
• Background analyzing technical performance and driving teams to improvement via direct management and oversight.
• Master’s Degree: Preferred.
• 5 or more years experience in Marketplace/Commercial Health Plan Operations.
• 5 to 10 years experience managing/supervising other. 

Other Skills:

• Proficient in Microsoft Office including Excel, Word, and PowerPoint.

The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the D.C. office.  Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training.  

AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more.  

The targeted hiring range for this role is expected to be between $134,800 and 223,100. 

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.

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.