Senior Vice President Quality & Health Equity

Location: Remote, United States

Primary Job Function: Management

ID**: 34313

AmeriHealth Caritas is seeking a talented, passionate Senior Vice President to lead our Quality and Health Equity team. The ideal candidate will have 10+ years of Managed Care Quality leadership of quality and performance improvement strategies and driving to quality outcomes in a multi-state, multi-product (Medicaid, Medicare) health plan organization.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 40 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.

We are 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.

If you want to make a difference in a key leadership role, we’d like to hear from you.

About the role:

In this role, you will be reporting to our EVP & Chief Medical Officer. You will be responsible for the AmeriHealth Caritas Family of Companies’ (ACFC) Quality and Health Equity Programs. This includes Medicaid, Medicare and Exchange lines of business and all geographies. You will lead the enterprise quality strategies, performance improvement and operating models which lead to the industry leading health plan ratings and health outcomes. This role ensures that the AmeriHealth Family of Companies Health Plans’ executes NCQA, CMS and/or ACA Qualified Health Plan related certification requirements in all of its components: Assurance of compliance to quality, health equity, NCQA, continuity & coordination of medical and social care standards and best practices; policies and processes in place which ensure standards are met; measurement and monitoring of quality performance; and performance improvement structures in place. You will also be responsible for the oversight and governance of Quality Operations including HEDIS report production vendor management and will ensure analytics needed to support the quality program are in place, whether sourced within the quality organization or working in strong collaboration with other enterprise analytics functional area.

In this role you will have the opportunity:

• Design and lead our enterprise quality strategy, quality operations and quality operating model including enterprise-wide population-based quality programs (Medicaid/ACA/Medicare/HEDIS/NCQA), health plan accreditation, CMS and ACA Qualified Health Plan requirements for ACFC products, services and health plan markets in all ACFC geographies.

• Lead the organization to 4 star and above health plan ratings for all lines of business and geographies.

• Deliver on the mission and promote health equity by embedding health equity throughout the quality program and operations.

• Manage the end-to-end HEDIS production process and manage the relationship and process with the Caritas HEDIS Oversight Auditor.

• Lead the enterprise accreditation strategy.

• Direct our HEDIS strategy clinical informatics organization.

Required Qualifications for this role include:

• 10+ years leading enterprise quality strategy and operations in a multi-state multi-product Medicaid/Medicare/ACA Managed Care health plan that achieved 4 star plus ratings

• 10+ years in a leadership role that required strong business acumen and financial skills to influence senior level executives and manage multiple large-scale projects simultaneously.

• 10+ years Health Plan Quality Experience that required experience with NCQA and HEDIS vendors, technology applications and data management approaches.

• 10+ years Population Health Experience in Healthcare Delivery System or Health Plan desired.

• Master’s degree required in a healthcare field of study.

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Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

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.

EOE Minorities/Females/Protected Veterans/Disabled