Health Insurance Operations Director jobs in Tennessee

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Idaho, and Iowa with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com.

The Executive Director is accountable for health plan success within a given market, with primary responsibility for leading local initiatives to achieve Member Engagement, Quality, Coding, Affordability, Growth and Retention goals. Sets strategy and prioritization in accord with corporate goals specific to the local market and ensures cross-organizational alignment. Is the executive representative in his/her market and engages new facilities with initial education and goal setting. Establishes and maintains clear leadership credibility and partnership with our external provider and broker partners. Collaborates on the products and solutions that help carry out our mission to improve patient outcomes. Is externally focused and facing.

Primary 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.
  
  Required Qualifications:
  
• Bachelor’s degree required with emphasis in business, marketing, economics, health or public policy preferred. Master’s degree would be a plus
• 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

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

This employer participates in E-Verify.

Experience

• 3 year(s): Health Care/ Managed Care
• 2 year(s): Executive Director

• 2 year(s): Risk Based Negotiation
• 2 year(s): Medicare Advantage

Education

• Bachelors or better

• Masters or better