Director, Network Strategy | ACA Exchange at AmeriHealth Caritas (Philadelphia, PA)

| Philadelphia, PA
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Lead the provider network strategy for health insurance exchange plans created under the Affordable Care Act (ACA). Reporting to the Corporate Director, Network Strategy, this position is tasked with developing an optimized and geocentric model to support high-value partnerships oriented to ACA exchange membership. Working with plan leadership, actuary, value-based programs, and local network management teams, this position will be responsible for developing contracting methodologies consistent with exchange practices, leveraging Medicaid, Medicare, and commercial experience, within and across markets. Ongoing management of unit-cost and medical loss ratio (MLR) performance within exchange contracts. Partner with ACA exchange leadership in key areas, including but not limited to, annual strategic plan development, provider education strategy, prioritizing enhancements to provider/health plan interface(s), STARS reporting, and provider impact analysis.

  • Ensures the achievement of financial, quality, and clinical objectives through accomplishment of LTSS initiatives.
  • Works with the Strategy and Innovation team to identify necessary business intelligence measures and acts as a liaison back to the network management teams where the reporting drives a required action.
  • Identifies and implements LTSS programs structured to achieve clinical, operational and organizational objectives.
  • Manages projects related to improving the overall workflow efficiency of the LTSS functions across the enterprise.

Education/ Experience:

  • Bachelor's degree.
  • Master's degree preferred.
  • 10 or more years Clinical vendor experience related to dental, occupational therapy, physical therapy, speech therapy.
  • Prior experience working for United, Aetna, and/or Centene (preferred).
  • Excellent written and oral presentation/communication skills.
  • Experience working in matrixed environment.
  • Effective leadership and analytical skills.
  • Ability to work collaboratively with internal and external stakeholders.
  • Ability to travel. (Up to 25%)
More Information on AmeriHealth Caritas
AmeriHealth Caritas operates in the Healthtech industry. The company is located in Philadelphia, PA, Newark, DE, Harrisburg, PA, Washington, DC and Southfield, MI. AmeriHealth Caritas was founded in 1983. It has 4500 total employees. It offers perks and benefits such as Flexible Spending Account (FSA), Disability Insurance, Dental Benefits, Vision Benefits, Health Insurance Benefits and Life Insurance. To see all 36 open jobs at AmeriHealth Caritas, click here.
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