Medicare Vendor Program Manager presso AmeriHealth Caritas

Your career starts now. We are looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we are 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 would like to connect with 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.

AmeriHealth’s Medicare Product Team oversees the Medicare product portfolio. It supports AmeriHealth’s Medicare Business and its critical Medicare and Medicaid integration initiatives, including overall growth, new market entry, and general plan performance. The Medicare Vendor Program Manager plays a vital role within the Medicare Product team to ensure plan supplemental benefits administered by external entities are operationally efficient and compliant, maximize the member experience, minimize grievances and complaints, and improve Stars scores.  

Responsibilities: 

• Manage AmeriHealth’s Medicare supplemental benefit vendor program end-to-end processes.
• Effectively develop and maintain relationships with critical supplemental benefits/Medicare vendors.
• Support supplemental vendor sourcing activities, including Request for Information (RFI)/ Request for Proposal (RFP) requirements and documentation in coordination with Corporate Sourcing.
• Work with crucial matrix partners (Legal, Compliance, Delegation Oversight, etc.) to develop and maintain vendor contracts and SOW.
• Support annual vendor implementation and go-to-market readiness activities.
• Manage and monitor vendor performance to Key Performance Indicators (KPIs) as stated in the Statement of Work (SOW).
• Monitor vendor network adequacy and support provider network expansion.
• Monitor and track Centers for Medicare and Medicaid Services (CMS) and state-level regulatory requirements and ensure vendor performance remains compliant.
• Work with matrix partners to track and resolve compliance deficiencies and CAPs.
• Engage vendors to resolve member issues (grievances and complaints) to ensure a high-level member experience.
• Lead monthly/biweekly meetings with all subcontracted vendors.
• Manage vendor invoice audits to support Medicare Finance and Actuarial to ensure accuracy and control costs.
• Lead process documentation, policies & procedures, project management, progress tracking, and process improvement efforts related to the abovementioned responsibilities.
• Other duties and responsibilities as assigned.

Education & Experience: 

• 3 to 5 years of experience in Medicare/Medicaid vendor account/contract management and operations.
• Bachelor’s Degree required.  
• Strong data analysis, presentation, communication, and negotiation skills.
• Ability to independently identify, research, and resolve issues.
• A decisive individual with a strategic focus and an operational, implementation, and detail-oriented perspective.
• Ability to exercise considerable judgment, maintain confidentiality, and act diplomatically.
• Skilled collaboration across multiple key business units and critical thinking capabilities.
• A strategic planner with sound technical skills, analytical ability, good judgment, and a strong operational focus.
• Demonstrated ability to manage multiple priorities and deadlines.
• Must be proficient in Microsoft Office applications, which include Word, Excel, PowerPoint, and Access.    

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.