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Director New Business Implementation - Individual Exchange Product

Company: Amerihealth
Location: Raleigh
Posted on: October 14, 2021

Job Description:

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 Director, New Business Implementation reports to the Exchange Segment President and is responsible for leading cross-functional business readiness activities to support new business implementations as AmeriHealth Caritas enters new ACA exchange markets. The Director, New Business Implementation directs the insurance application process for new states, including the Certificate of Authority application process through to approval and tracking the development and delivery of all other implementation deliverables. The Director also coordinates resources to evaluate regulatory questions as they arise and converts into actionable marketplace approaches and advocacy strategies.  Internally, Director works collaboratively across the enterprise to identify, document, and communicate exchange business requirements in support of end-to-end process development to ensure the successful implementation of Exchange business operations. The Director, New Business Implementation works with Customer Experience, Operations, Marketing and other process domains to optimize AHCs exchange offerings, and incorporate lessons learned, in each state. The Director is also responsible for guiding the implementation team with AmeriHealth Caritas’ IT organization to make necessary system and configuration changes to implement new exchange business. The Director executes on the exchange segment growth plan, and communicates growth goals to operations for incremental staff hiring. Another aspect of the role is to ensure the development of new business policies and procedures to support operational areas. The Director also provides guidance to inform the Medicaid RFP process for states that encourage or require potential Medicaid managed care insurers to offer exchange products.

The Director, New Business Implementation works on problems of complex scope, requiring the exercise of independent judgement and the application of a high degree of subject matter expertise with limited oversight, often requiring evaluation of multiple competing factors across functional areas. The Director’s contributions will have an impact on the growth, cost, and customer satisfaction of the Exchange segment. The Director coordinates the work efforts of medium to large teams, capable of delivering on several tasks simultaneously within tight time frames.

Directs internal implementation of new ACA markets :

  • Complex scope in multiple geographies

Oversees implementation financials including business impact:

  • Provides accurate performance reporting and forecasting to management

Establishes and maintains stakeholder relationships:

  • Manages mid/high-level stakeholder relationships

Supervises business team:

  • Supervises the work of full-time employees and contractors of a team size of less than 15 people
  • Provides performance feedback on direct reports
     

Education/Experience:

  • Bachelor’s Degree.
  • Master’s Degree.
  • Detail oriented, ability to work in “gray areas” towards a solution.
  • Strong organizational and communication skills along with the ability to communicate with all levels in the organization.
  • Demonstrated ability to learn and apply the learning in a business environment. Ability to communicate business and financial analytics and reports across disciplines and to senior executives.
  • Proven ability to work across organizations and rapidly gain / build trust with stakeholders.
  • Advanced proficiency in Microsoft Office Word, Excel, Outlook, PowerPoint, SharePoint and Visio.
  • 5-10 years leading Exchange implementation or similar implementation leadership roles in Medicaid and/or Medicare.
  • Demonstrates a strong working knowledge of key health plan business functions and capabilities, CMS and state healthcare regulations, operational policies, processes, and methodologies applicable to health plan business readiness activities. 
  • Must be willing to travel up to 25%
  • This position is teleworker eligible

Keywords: Amerihealth, Raleigh , Director New Business Implementation - Individual Exchange Product, Other , Raleigh, North Carolina

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