Medicare Performance Management Oversight Specialist

About AmeriHealth Caritas

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, 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 .

Role Overview

The Medicare Performance Management Oversight Specialist will report to a Manager of Medicare Performance Management and play a crucial role in ensuring the effective monitoring, evaluation, and optimization of Medicare Program Performance. Working closely with senior team members, you will contribute to the analysis of data, development, and monitoring of performance metrics, and implementation of strategies to enhance the quality and efficiency of Medicare operations. This role offers an opportunity to gain valuable experience in healthcare administration, data analysis, and regulatory compliance within the Medicare landscape.

Work Arrangement

• Remote within the United States

Responsibilities

• Assist in collecting, analyzing, and interpreting data. Collaborate with the team to identify trends, anomalies, and potential areas of improvement based on data insights.

• Prepare reports and presentations to communicate findings to senior management.

• Maintain accurate records of performance and regulatory data, metrics, and improvement initiatives.

• Monitor internal performance management system, generate reports to support stakeholders.

• Develop subject matter expertise in performance management system, operational, reporting and regulatory requirements for all Medicare lines of business.

• Track important issues and work cross-functionally with business owners to escalate risks or barriers while maintaining strong lines of communication.

• Pro-actively escalate barriers to manager and senior associates to resolve issues and mitigate risk.

• Stay informed about relevant regulations, policies, and guidelines related to Medicare and the Managed Care program(s).

• Assist in ensuring that Medicare operations adhere to regulatory requirements and industry standards.

• Coordinate with Medicare Performance Management, Compliance and Business Owners to identify risks and barriers to regulatory compliance.

• Adheres to AmeriHealth Caritas policies and procedures:

  • Creates and supports an environment that fosters teamwork, cooperation, respect, and diversity.
  • Instills a work culture of continuous process improvement, innovation, and quality; and
  • Demonstrates and supports commitment to corporate goals and objectives.

• Performs other related duties and projects as assigned.

Education/Experience

• Associate's Degree or equivalent education and/or experience may be considered

• 2+ years of managed care experience

• Advanced Microsoft experience (Excel, PowerPoint, SharePoint) highly desired

• Knowledge of DSNP programs integration preferred

Other Skills

• Knowledge of Medicare Managed Care

• Prior experience with computer-based data processing including Microsoft Office products, and database application

• Information analysis for problem-solving and solution development

• Strong verbal and written communication skills

• Experience with prioritizing the demands of multiple tasks while meeting essential deadlines

• Self-starter -- initiates tasks and projects independently, demonstrating a proactive approach to work

• Effectively allocates time to tasks, balances multiple responsibilities, and meets deadlines

• Takes ownership of responsibilities, consistently delivering results and communicating progress to stakeholders

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.