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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.
Lead the provider network strategy for Long-Term Services and Supports (LTSS). Reporting to the Corporate Director, Network Strategy, this position is tasked with developing optimized and community-based models to support high-value partnerships oriented towards long-term support membership. Working with plan leadership, actuary, value-based programs, and local network management teams, this position will be responsible for developing contracting methodologies consistent with LTSS best-practices, leveraging Medicaid and Medicare experience, within and across markets. Ongoing management of unit-cost and medical loss ratio (MLR) performance within exchange contracts. Ensures network provides person-centered, inclusive approach to effective and efficient community-based care in traditional and non-traditional care settings. Partner with LTSS leadership in key areas, including but not limited to, annual strategic plan development, provider education strategy, prioritizing enhancements to provider/health plan interface(s), STARS reporting, and provider impact analysis.
- Ensures the achievement of financial, quality, and clinical objectives through accomplishment of LTSS initiatives.
- Works with the Strategy and Innovation team to identify necessary business intelligence measures and acts as a liaison back to the network management teams where the reporting drives a required action.
- Identifies and implements LTSS programs structured to achieve clinical, operational and organizational objectives.
- Manages projects related to improving the overall workflow efficiency of the LTSS functions across the enterprise.
- Bachelor's degree.
- Master’s degree preferred.
- 10 or more years Clinical vendor experience related to dental, occupational therapy, physical therapy, speech therapy.
- Prior experience working for United, Aetna, and/or Centene (preferred).
- Excellent written and oral presentation/communication skills.
- Experience working in matrixed environment.
- Effective leadership and analytical skills.
- Ability to work collaboratively with internal and external stakeholders.
- Ability to travel. (Up to 25%)