AmeriHealth Caritas Director Plan Operations & Administration in New Castle, Delaware

Director Plan Operations & Administration


Description

AmeriHealth Caritas Delaware is excited to have been chosen as one of the Medicaid managed care plans for the Diamond State Health Plan and Diamond State Health Plan- Plus programs. Backed by a national organization, we have long-term experience serving the Medicaid population in neighboring states. We are committed to delivering health care through innovative services and programs and are looking forward to helping Delaware become an even healthier state.

Responsibilities:

The Director Plan Operations & Administration serves as the contract manager and liaison between the state, health plan and enterprise functions and is accountable for all matters pertaining to the state contract. This position will maintain in depth knowledge of the state program contractual and regulatory requirements (benefit and payment rules, data and information submission specifications, performance and service level requirements, etc.) and will ensure ACFC contract requirements are met by the plan, local, regional and corporate resources.

This position is responsible for internal operational functions and oversight of corporate functions that support key plan requirements such as claims processing and encounter data submissions and corrections. Responsible for overseeing the submission of specific information to corporate, based on the plan’s provider contracts, for configuration of the system to support payment of claims. Responsible for ensuring that claim payments, once configuration has been completed, are consistent with the terms of the contract.

This position will maintain up-to-date Policies and Procedures for all local functions, conforming to regulatory requirements, tracks State Bulletins to identify changes and operational impacts, communicates them, and marshal local, regional and corporate resources to make necessary system and process changes to meet the requirements.

Will support the execution, in collaboration with the Regional CFO and CMO, of cost containment initiatives. Responsible for developing action plans and tracking results for operational cost containment initiatives. Proactively identify risks that would impact the Plan’s ability to meet enterprise and local strategic and financial goals and develop strategies to mitigate the risks.

Education/Experience:

  • Bachelor's degree with a minimum of 5-10 years of experience in Medicaid/Medicare Operations
  • Previous experience working in and managing relationhips in a matrixed environment
  • Previous management experience required.