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Senior Vice President Quality & Health Equity

Location: Remote, United States

Primary Job Function: Management

ID**: 34313

Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, 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. 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 would like to connect with 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.

Responsibilities:

Reporting to the EVP & Chief Medical Officer, the SVP Quality & Health Equity will be broadly responsible for the AmeriHealth Caritas Family of Companies’ (ACFC) Quality and Health Equity Programs, inclusive of performance improvement, across all lines of business and in all geographies. The role will ensure 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. The role will also be responsible for the oversight and governance of Quality Operations include 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.

Key responsibilities include:

• Quality Structure, Program and Operations for Enterprise, Lines of Business & Medicaid Markets – Designs and leads the enterprise quality strategy and operations 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. Ensures that the strategy is constructed with an enterprise core and with the flexibility needed to support the unique requirements of Medicaid, DSNP and ACA Markets.

• Health Plans Ratings, Quality & Health Equity Accreditation – Accountable and responsible to lead the organization to 4 star and above health plan ratings for all lines of business and geographies, including identifying the key strategic drivers, collaborating with population health, clinical operations, member engagement/contact center, provider network management and service operations to ensure that strategies are designed, built and implemented throughout their organization.

• Health Equity- Delivers on the mission and promotes health equity in support of all lines of business markets and associates by embedding health equity throughout the quality program and operations, and through accreditation, data informed processes and evidence informed training. Monitors and analyzes industry trends, research, and best practices related to health equity and quality healthcare, and make recommendations for organizational improvement.

• Performance Improvement – Accountable for establishing and operating the performance improvement structure across all relevant health plan functional areas, member and provider satisfaction & experience and health equity. Establishes and refines metrics and performance indicators to track progress towards goals, effectiveness of initiatives, and regularly report outcomes to senior leadership.

• HEDIS Quality Performance Reporting, Strategy & Production- Leads the management of the end-to-end HEDIS production process including data sourcing and strategy and manages the relationship and process with the Caritas HEDIS Oversight Auditor. With support of Clinical Vendor Management team, oversees management of HEDIS analytics and third party vendors which support HEDIS reports.

• Enterprise Quality and Health Equity Accreditations – Leads enterprise accreditation strategy, and oversees and monitors implementation of standards inclusive of delegation oversight and auditing.

• Clinical and Quality Storytelling- Accountable for assisting the organization in identifying key proof point and creating narratives with insights and data illustration to best demonstrate the outcomes and value created by the organization.

• New business development- Ensures that new business growth in all products related to quality are best in class and support the ultimate vision and guidance of the enterprise strategy.

• Technology Enablement– Leads the HEDIS strategy clinical informatics organization which is responsible for enablement and oversight of the clinical informatics applications, analytics and underlying data infrastructures which support the activities of the population health and quality organizations. Collaborates with matrix partners in Information Systems, Digital and other analytics areas on high impact projects.

• Key Success Factors -- This person will need to perform in a fast-paced environment, will have an collaboration mindset, sets high standards, and will focus on identifying high value solutions to challenging business problems. This position requires someone with strong business acumen, exceptional communication skills and the ability to make complex concepts simple and easy to understand. A few key success factors include:

• Health Equity Expertise: In-depth knowledge of health equity concepts, indices, principles, and best practices, with the ability to apply them to drive positive change in the managed care industry.

• Cross-functional Teaming and Collaboration: The ability to work across multiple functional areas that help to enable the Quality strategy including, but not limited to, Care Management, Provider Engagement, Member Engagement, and Digital Solutions teams.

• Industry Knowledge: Strong understanding of Quality systems, Quality operations, and the dynamics of health disparities and social determinants of health.

• Executive Communication Skills: Ability to communicate effectively in written, oral and presentation formats to executives, peers, markets and teams.

Education/ Experience:

• Master’s or doctorate degree required. Degree demonstrating healthcare and/or technical background and skills highly desirable.

• 10+ years Managed Care Quality Leadership Experience in a multi-state multi-product health plan organization.

• 10+ years Healthcare Leadership/Management.

• 10+ years Quality Initiative Development; Medicaid/Medicare/ACA Managed Care experience.

• 10+ years Health Plan Quality & HEDIS experience.

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

• Experience with NCQA and HEDIS vendors.

• Experience with health plan technology applications.

• Experience with data management approaches.

• Ability to manage multiple large-scale projects simultaneously.

• Ability to influence senior level executives.

• Strong business acumen and financial skills.

• Exceptional communication skills and the ability to make complex concepts simple and easy to understand.

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