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 Newtown Square, PA, 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.
Position Overview: The Vice President of Medicare Strategy Execution has a critical leadership role and is responsible for successfully implementing and optimizing our Medicare strategy. This individual will lead a cross-functional team, including Medicare Stars, Risk Adjustment, and Product Development & Implementation, to achieve key performance indicators related to quality, risk accuracy, and market competitiveness. The VP will be a strategic thinker, a strong collaborator, and a results-oriented leader with a deep understanding of the Medicare landscape.

EDUCATION & EXPERIENCE:

• Bachelor’s Degree required.
• 5 or more years of experience in implementation and business planning.
• Experience managing different groups and supporting collaboration across various business units to advance strategic goals.
• Ability to work effectively with people at all organizational levels; demonstrated leadership ability in a team environment.
• Strong entrepreneurial spirit and willingness to take initiative.
• Ability to manage the progress of a strategic goal and ensure accountability of its success; ability to anticipate risks and manage accordingly.
• Experience in synthesizing complex analyses and effectively communicating to leadership.
• Deep understanding of Medicare Stars, risk adjustment, and product development.
• Strong knowledge of CMS regulations and guidelines.
• Proven ability to drive results in a fast-paced environment.
• Demonstrated ability to build and maintain strong relationships with internal and external stakeholders.

• Translate the overall Medicare strategy into actionable plans and initiatives, ensuring alignment across all relevant departments.
• Lead and direct the Medicare Stars team to achieve and exceed targeted Star Ratings, focusing on quality improvement initiatives and member experience.
• Oversee the development and execution of comprehensive risk adjustment strategies to ensure accurate and compliant revenue capture.
• Drive the development and implementation of innovative Medicare Advantage products that meet market needs and regulatory requirements.
• Foster strong relationships with internal stakeholders, including actuarial, finance, compliance, and marketing, to ensure seamless execution of Medicare initiatives.
• Establish and monitor key performance indicators (KPIs) related to Stars, risk adjustment, and product performance, providing regular reports and insights to senior leadership.
• Ensure all Medicare activities adhere to Centers for Medicare & Medicaid Services (CMS) regulations and guidelines, stay abreast of changes, and implement necessary adjustments.
• Build and lead a high-performing team, providing coaching, mentoring, and development opportunities to enhance individual and team performance.
• Develop and manage budgets for the Medicare Stars, Risk Adjustment, Product Development, and Implementation departments, ensuring efficient resource allocation.
• Conduct ongoing market analysis and competitive intelligence gathering to identify opportunities and threats, and adapt strategies accordingly.
• Manage relationships with external vendors and partners related to Medicare Stars, risk adjustment, and product development.