<p>Your career starts now. We're looking for the next generation of health care leaders.</p> <p>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.</p> <p>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.</p> <p>Discover more about us at www.amerihealthcaritas.com.</p> <p>Job Summary</p> <p>Reporting to the Senior Vice President, the Vice President, HEDIS / Stars Risk Adjustment Performance Strategy serves as the leader responsible for driving the Quality Performance Reporting & Analytics and Risk Adjustment for Medicaid Quality, Medicare Stars, and Exchange QRS. This leader is accountable for driving strategy and insights for the local markets' quality intervention, leading the HEDIS program including the data collection and reporting, creating tools /reports to support the quality and enterprise functions, and developing the enterprise's clinical / supplemental data strategy. The candidate will bring deep expertise in HEDIS, CAHPS, and related quality measures, and excels at translating complex data into strategic insights. Operating in a fast-paced environment, they must combine operational precision with a strong business acumen and clear communication skills to influence decisions and drive transparency and collaboration across all levels. It combines expertise in risk adjustment and quality performance, with oversight of strategies that impact HCC coding accuracy, risk score integrity, and quality measures (HEDIS/STARS). This position will deliver results on high-impact projects collaborating with Informatics to support data driven decision making.</p> <p>Major Accountabilities:</p> <p>Strategic Leadership:</p> <ul> <li>Develop and execute enterprise and local-market strategies for HEDIS, NCQA / CMS Stars, and other performance measurement initiatives. </li><li>Partner with executive leadership to align and establish performance goals with financial and clinical objectives. </li><li>Anticipate and respond to regulatory and industry changes affecting quality measurement and performance. </li><li>Partner with Informatics team, IS and enterprise functions to develop data and analytics to drive execution and performance for all Products / LOBs. </li><li>Lead, mentor, and develop high performing teams including directors, managers, coders, auditors, and analyst. </li></ul> <p>Program Oversight:</p> <ul> <li>Lead the planning and execution of HEDIS data submission and reporting, including prospective and hybrid project collection. </li><li>Manage the Hybrid project lifecycle including chase / abstraction strategies and workflows, training, communications, reporting, and tools that enable quality and local market. teams and brings agility to the project. </li><li>Drive the supplemental data strategy to optimize HEDIS data capture for the enterprise informed through outcomes / ROI data. </li><li>Oversee CAHPS and Stars analytics and improvement strategies for Medicare Advantage. </li><li>Ensure readiness for NCQA accreditation and other quality audits. </li><li>Manage external vendor relationships including performance monitoring / SLA tracking to ensure high quality performance (e.g., chart retrieval vendors). </li><li>Serve as primary liaison with local market provider network teams on Quality analytics and supplemental data opportunities. </li><li>Deep knowledge of HCC Coding, risk adjustment models (CMS, HHS,STARS, HEDIS, and value based care. </li><li>Risk adjustment program oversight with leading design, implementation, and monitoring. </li><li>Integrate risk adjustment initiatives with STARS, HEDIS and other quality improvement programs to maximize performance scores and financial incentives. </li></ul> <p>Operational Excellence:</p> <ul> <li>Build and manage high-performing teams and talent including HEDIS analytics, quality reporting, and project management </li><li>Drive continuous improvement opportunities to streamline reporting workflows, enhance vendor partnerships and optimize data abstraction and management </li><li>Direct advanced analytics functions to monitor risk scores and quality performance. Translate insights to actionable recommendations for senior leadership and stakeholders </li></ul> <p>Performance Analytics:</p> <ul> <li>Oversee development of dashboards, predictive models, and benchmarks for tracking and forecasting performance from executive reporting through day-to-day reporting to support actionable insights </li><li>Measure and report ROI of quality interventions to help inform improvement opportunities. </li><li>Present actionable insights and performance trends to senior leadership, regulatory, and provider networks. </li><li>Collaborate with Informatics team and other enterprise functions (e.g., Finance, Actuarial, etc.) to develop advanced quality analytics tools. </li><li>Oversee develop key KPIs for average risk score, year over year RAF delta, coding gap closures, suspect condition identification rate, chart retrieval and review rate, HEDIS gap closure rate, STARS measure performance, and preventative screening performance. </li></ul> <p>Education/Experience:</p> <ul> <li>Master's Degree. </li><li>10 or more years Healthcare Leadership/Management; Clinical Program Development; Medicaid/Managed Care Experience, QUALITY and HEDIS. Experience should be inclusive of and at the level of responsibilities described in the summary. </li></ul> <p>Other Skills:</p> <ul> <li>Ability to manage large scale projects simultaneously. </li><li>Ability to influence senior level executives. </li><li>This position requires someone with proven strong business acumen, coupled with the ability to communicate findings to both business and IT leaders in a way that can influence how the organization approaches a business challenge. </li></ul> <p>Our Comprehensive Benefits Package</p> <p>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.</p>