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American Health Partners · 3 weeks ago

Executive Director of Health Plan Operations

Indianapolis, IN

Full-time

Onsite

Lead/Staff, Director/Executive

3+ years exp

American Health Partners is a division focused on Institutional Special Needs Plans for seniors in long-term care. The Executive Director is responsible for leading initiatives to achieve member engagement, quality, affordability, growth, and retention goals while collaborating with various teams and external partners.

Elder CareHealth CareHome Health CareNursing and Residential Care

Responsibilities

Implements and executes the Provider Partner Engagement strategy; establishes strong, collaborative relationships with provider partners in support of all Quality, Collaboration and Affordability goals

Responsible for working cross-organizationally with local health plan team, Network, Market Medical Director and Marketing

Responsible for execution of the Growth and Retention strategy in partnership with Sales and Marketing; is the face of the market to external channels

Responsible for achieving market-level engagement goals and is accountable to build market share based on goals

Actively collaborates with all Plan functions (Product, Sales, Marketing, Member Experience, Finance, Network, Clinical, Quality, Operations and Local Care Delivery and Care Management) to leverage local market knowledge and establish and drive plans across all levers of the P&L

Cultivates and sustains effective executive level relationships in partnership with Provider Business Partners built on mutual benefit, implementing solutions which position providers for success executing plan’s Model of Care, reducing the total cost of care and improving the health and healthcare experience of members

Monitors, interprets and presents analytic reports on cost, quality, utilization, patient experience and risk adjustment at the entity/location level and in aggregate

Identifies challenges and barriers that may prevent provider partners from meeting desired outcomes and facilitates results-driven solution focused discussion to achieve success

Qualification

Health care experienceMedicare Advantage knowledgeFinancial acumenAnalytical skillsCommunication skillsRelationship buildingLeadershipTeam facilitationPresentation skillsNegotiation skills

Required

Bachelor's degree required with emphasis in business, marketing, economics, health or public policy preferred

3+ years of experience in health care / managed care organization with demonstrated track record of increasing responsibility and accountability to include leading and facilitating teams

Experience in a Medicare Advantage or other government-funded healthcare business is highly preferred

Experience with value base and risk based negotiating arrangements

In-depth experience with health care providers / networks, CMS Quality Programs (Star ratings, HEDIS measures), Part D and clinical quality

Demonstrated strong financial acumen and analytical skills

Strong written and verbal communication skills to include experience in developing and delivering concise presentations, including well-developed interpersonal skills used to influence the behavior of others across a highly-matrixed organization

Demonstrated success building relationships with external executives and stakeholders; possesses a strong ability to persuade

Track record of meeting business goals via driving disciplined, fact-based decisions and executing with discipline and urgency