AmeriHealth Caritas Market President Prestige in Palm Beach Gardens, Florida

Market President Prestige

Location: Palm Beach Gardens, FL

Telecommuter?: No

ID**: 14482

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 Market President will provide the strategic vision and operational expertise to successfully lead the Prestige Health Choice Plan. In this role, the Market President will be a proactive, strategic, and decisive leader who demonstrates a commitment to ensuring that our members have access to high quality health care services. The Market President is responsible for cultivating AmeriHealth Caritas' presence and brand recognition through establishing influential relationships with key stakeholders and by developing partnerships with key providers, associations, and community leaders. Relationship development with the state’s Medicaid agency is essential. The Market President will lead the effective and efficient operations of this Health Plan directly and/or indirectly overseeing Medical Affairs, Provider Network Management, Provider Network Operations, Quality, Population Health, Marketing and/or Community Outreach, Compliance and Regulatory Affairs, Community Investment and Legislative affairs, HR, Finance and Information Services. In collaboration with these corporate and regional stakeholders, this executive will lead the strategic development, growth, and operations of the health plan starting with capture planning and RFP response development. Upon selection (if newly won or re-procured), this individual will lead the market entry/implementation activities to ensure stability as the health plan matures. The Market President will demonstrate a deep understanding of the defined state’s Medicaid market and possess the qualities that support our core values and mission which will result in successful achievement of financial, membership, and plan goals.

Key Responsibilities

  • Formulate and implement business plans and strategies to ensure profitable operations, meet short-term objectives, and support long-term growth, success, and competitive position in the market.

  • Be accountable for full profit and loss responsibility and develop and implement adequate measures to meet the fiscal needs of the company and maintain an effective system of budgetary control.

  • Monitor and analyze the changing Medicaid landscape and recommend programs and policies to proactively address the changing needs of the membership.

  • Identify State and/or product-specific priorities and determine the appropriate strategic approach that will drive business growth and differentiate AmeriHealth Caritas in the marketplace.

  • Work collaboratively with Enterprise Operations to ensure all back office functions are exceeding the requirements of the relevant contract(s).

  • Strive to ensure the overall level of quality for delivery of medical services meets or exceeds appropriate industry standards.

  • Provide personal leadership that encourages employee productivity and responsiveness to the needs of current and prospective members, providers, and other community and regulatory customers.

  • Ensure programs are established and monitored to comply with all relevant federal, State, and other local regulations.

  • Foster and builds a collaborative partnership with a cross functional internal team and external constituents/stakeholders.

  • Build a best-in-class team that reflects the AmeriHealth Caritas culture and supports the line of business.

  • Ability to collaborate, navigate and work in a complex matrixed reporting environment.

Education/Experience:

  • Bachelor’s Degree (BA/BS Business or related/Health Care Industry)

  • Master’s Degree preferred

  • Clinical background beneficial, but not required

  • 5-10 years of operational experience in Medicaid/Medicare/LTSS

  • 10 or more years' progressive responsibility in Business or Government, health care management experience required; previous experience in a health plan leadership role preferred

  • Credibility, knowledge, and experience working within the state of Florida strongly preferred

  • Demonstrated knowledge and experience in a leadership role in corporate or health plan operations including enrollment, member services, provider relations, regulatory compliance, contract negotiations, quality, government relations, and medical management strongly preferred

  • Experience working in a matrixed environment strongly preferred. Understands how to collaborate, navigate and work within a structure with many direct and indirect reporting relationships; while still being the one accountable for the overall P&L of the plan

EOE Minorities/Females/Protected Veterans/Disabled