Vice President, Corporate Network Policy & Planning

Your career starts now. We’re looking for the next generation of healthcare 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 healthcare 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, 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.

About this job:

The Vice President of Corporate Network Policy and Planning is responsible for developing, managing, and executing the enterprise-wide policies and standardized processes impacting the entire provider continuum from network strategy and planning through provider setup in Facets and ultimately accurate provider payment, inclusive of integration activities within and external to our organization. This position will impact the provider continuum at all levels of the organization, including corporate, product, and local market provider-related operations and processes. In addition, this position will oversee the overarching strategic and budgeting function for the delivery system and optimal operating model. Manages National Contacts, Network Strategy, CPNM Communication and Training, and Health Delivery Systems functions. This position must have and maintain a deep knowledge of managed care, network contracting, operations, and their impact(s) across the enterprise, including health plans and external stakeholders. The position will be critical in building trust and establishing stakeholder relationships focused on open communication with Enterprise and external leaders.

Responsibilities: 

Developing, managing, and executing the enterprise-wide policies and standardized processes function

• Oversees the assessment, development, and implementation of enterprise policies, including associated controls that drive processes across the provider continuum to ensure standardized, financially transparent processes.
• Serves as Project Sponsor for the enterprise-wide multi-year initiative to re-imagine provider experience workflow and enable the new technology platform (Project LIFT) and any new enterprise contracting platforms.
• Drives to a standard global Provider Delivery operating model, including assessing existing processes and structures at all levels of the organization and developing an enterprise approach (inclusive of the design, implementation, process, measure, owner, and resources) to enhance integration, optimization, and standardization of provider related activities.
• It requires research, solution development, financial modeling, implementation management, reporting, training, and communications.
• Drives a standardized approach to provider contract negotiations with controlled, consistent exception processes.
• Supports an enhanced operating model, serving as a recognized change agent for the enterprise by influencing acceptance of the change and defining an appropriate implementation plan.
• Oversees the Provider Communications and Training teams, with a goal to standardize and consolidate provider-related requirements, communications, and training needs to balance fiduciary responsibility while reducing administrative burden.
• Assesses and redefines provider satisfaction and demonstrative avenues to materially impact results.

Oversee the overarching strategic and budgeting function.

• Oversees the Network Health Value optimization (HVO) activities and drives the achievement of the Corporate financial goals.
• Oversees national contracting strategy and execution, including management of subcontractor vendor relationships such as NEMT.
• Aligns strategic goals for optimizing the Corporate Network function, including the CPNM budget development and ongoing monitoring, along with recommendations to restructure and/or redefine roles and responsibilities to ensure the market's future needs are achieved.

Cross-departmental optimization and CPNM functional oversight

• Oversees National Contracts, Network Strategy, Health Delivery Systems, Communications and Training functions.
• Works closely and aligns with Network Pricing, Network Development, New Business, & Network Strategy Analytic teams within CPNM.
• Creates and influences opportunities to positively address the organization’s agility and scalability for growth and change.
• Provides leadership and direction to resolving escalated, cross-functional issues that impact providers and the functions that support provider activities. Informs and supports the development and implementation of best practices across the provider continuum to ensure coordination for optimal outcomes, reducing redundancy in activities.
• Provides leadership and direction to integration opportunities impacting the provider-related functions with internal and external partners.

Organizational leadership

• Provides guidance and direction to the other functional leaders within the Corporate Network and, where appropriate, acts on behalf of the Corporate Network SVP within the Network department and externally to other corporate departments.
• Collaborates and influences internal and external stakeholders across all areas of the organization, including, but not limited to, Business Development, Contracting, Provider Performance, Pricing, Actuary, Communications, Training, Human Resources, Government Relations, IT, Legal, Regulatory, Compliance and each of our Markets and Products.

Education & Qualifications:

• Bachelor's degree required.
• MBA, MHA, MPA degree preferred.
• 10 plus years of progressively responsible experience in healthcare operations with expertise in managed care networks.
• Proven experience interpreting and creating global policies and processes, financial and programmatic budget analysis, and understanding government and regulatory standards.
• Excellent written, oral, and presentation skills.
• Ability to effectively work in a matrixed environment.
• Effective leadership and analytical skills.
• Ability to work collaboratively with internal associates and external stakeholders and drive expedited resolution.

 Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.