Manager, Medicare Performance Program Oversight

Location: Remote, United States

Primary Job Function: Medicare

ID**: 34248

Your career starts now. We are looking for the next generation of healthcare 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 healthcare 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:

The Medicare Performance Program Oversight Manager will report to the Medicare Regulatory Data & Analytics Manager and lead a team that manages the operational performance oversight of Medicare business areas relative to Product, Regulatory Submissions Administration, Medicare Online Management Tool Administration, and Communications.

The MPM Program Account Manager is responsible for developing and maintaining the operational oversight of the Performance Management team under their direct scope of responsibility while partnering with compliance, leadership, and departmental business owners to create and operationalize an oversight and monitoring framework, data aggregation/reporting, and risk assessments of performance by contractual and regulatory requirements.

With a focus on oversight of contractual and regulatory performance for Medicare plans in the areas of:

• Product;

• Regulatory Submissions Administration;

• Medicare Online Management Tool Administration;

• Communications;

The MPM Program Oversight Manager is responsible for developing key performance indicators and supporting metrics to proactively inform compliance, leadership, and departmental business owners of possible risks and issues with compliance performance and develop remediation and correction action plans as appropriate.

• Responsible for strategy, implementation, day-to-day operations, and supervising a Medicare Performance Management Specialists team.

• Responsible for maintaining subject matter expertise of operational, reporting, and regulatory requirements for all Medicare lines of business.

• Single point of contact for all performance monitoring issues related to the assigned scope of Medicare business areas and is responsible for maintaining strong lines of communication with the leads for those respective business areas, leadership, and compliance teams.

• Overseeing the implementation and effectiveness of the Medicare Performance assigned scope of areas to measure monthly and quarterly performance and score against contractual and regulatory requirements.

• Overseeing and executing the operational effectiveness of the Medicare Performance Program Oversight Program while measuring the program's success against milestones and industry-standard measures.

• Leadership and direction of a team of Specialists, Analysts, or Project Managers that are developing, implementing, and executing work, monitoring, and communications plans.

• Provide leadership to the teams for ingesting performance data, triaging to business units, aggregation of results, and reporting overall performance of the Medicare Performance Program Oversight areas.

• Partners with internal departments, including compliance and leadership, to ensure the scope of Medicare business areas is compliant with requirements.

• Providing leadership analytical performance metrics on all task performance requirements. Taking proactive preventative steps to resolve issues and manage risk. Partners with the business area leaders to coordinate reviews and prepare for annual oversight and regulatory audits; examine monitoring findings and respond to cited deficiencies; make recommendations for corrective actions and monitor remediation and corrective action plans.

• Manage staff, including, but not limited to, recruiting, selecting, orienting, training new staff, monitoring of day-to-day activities of staff, monitoring staff performance, mentoring, training, cross-training, handling questions or issues raised by staff, encouraging staff to provide recommendations for relevant process and systems enhancements, among others.

• Adheres to AmeriHealth Caritas policies and procedures:

• Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity; instills a work culture of continuous process improvement, innovation, and quality; and demonstrates and supports commitment to corporate goals and objectives.

• Performs other related duties and projects as assigned.

Education & Experience:

• Bachelor’s degree or equivalent education and experience may be considered

• 3 to 5 years experience in contract and Medicare regulatory requirements analysis in Dual-Special Needs or Medicare-Medicaid Plans.

• Supervisory/management experience.

• Direct experience and demonstrated subject matter expertise in program requirements, including Medicare/Medicare - DHHS/CMS contractual requirements and Code of Federal Regulations (CFR) 42.

• Demonstration of both qualitative and quantitative analytical skills.

• Proven ability to work with diverse people, including physicians, support staff, coworkers, and management.

• Demonstrated ability to research issues and bring about resolution either directly or with the assistance of others.

• Demonstrated critical thinking and problem-solving skills.

• Strong written and verbal communication skills.

• Strong elicitation and process documentation skills.

• Strong organizational and communication skills to build and foster effective relationships.

• Ability to travel up to 25% of the time, as needed.

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 include remote options, hybrid work schedules, competitive pay, paid time off, 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