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Director Contract Performance

Company: AmeriHealth Caritas
Location: Newark
Posted on: February 14, 2020

Job Description:



Director Contract Performance



Location



Newark, DE



Telecommuter?



No



ID**

18339






Job BriefResponsible for developing systems, and tools to ensure sustainable improvement on key performance metrics



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.


Responsibilities:

The Director Contract Performance reports to the Market President and is responsible for developing systems, and tools to ensure sustainable improvement on key performance metrics.

S/he must work closely with business owners across the enterprise to identify streamline workflows and processes so that they operate more efficiently and profitably, define reporting requirements, and initiate projects to improve current state functions that perform below required levels.

A key function of this role is to implement special projects as assigned by the Market President and provide a monthly consolidation of the Plan's operational performance. The incumbent will be responsible for providing a cross-functional review of key measurements and performance indicators, and providing business improvement recommendations.

Key Responsibilities


  • Research, collect and confirm key operational measures for DHCF contract, NCQA, HEDIS, and AOP goal compliance. Works across the enterprise and with key external stakeholders to develop measures and operational processes to ensure workflows and processes meet all contractual, regulatory, and accreditation-based requirements.

  • Coordinate with Executive staff to develop, communicate and track progress on the annual and three year strategic/business plan.

  • Assist Quality Management and Compliance in preparation and execution of LOB's audits. To include, organization of documentation, completion of audit forms, auditing reporting and management of responses to specific questions from the auditors.

  • Coordinate the LOB response to contract audits, as well as ad-hoc data requests. Includes developing presentations, validating data, and coordinating with cross functional areas to complete and provide relevant information and other external auditors.

  • Organize and facilitate short-term productivity or quality improvement projects related to operations, and develop clinical oversight programs focused on reducing unnecessary utilization and excessive cost.

  • Partner with business owners and corporate reporting areas to standardize processes, develop relevant metrics, and design scorecards highlighting LOB performance in multiple key areas.

  • Provide operational oversight and business development functions in support of the LOBs clinical/medical relationships - includes attending user meetings, by attending user meetings and serving as Chief Point of Contact for initiatives and other key functions.

  • Coordinate all reporting requests and manage the content of the ACDC specific reporting library in the Perform Rx portal.

  • Create transition plans for moving SWAT processes into day-to-day operations.

    Education/Experience:


    • Bachelor's Degree.

    • Eight (8) to ten (10) years of experience.



Keywords: AmeriHealth Caritas, Newark , Director Contract Performance, Executive , Newark, Delaware

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