Director Service Coordination & Oversight

Amerihealth Caritas•,

4d•Hybrid

About The Position

The Director Service Coordination Oversight provides independent monitoring and governance of Service Coordination regulatory compliance, operational controls, quality performance, and corrective-action effectiveness. The role identifies systemic risk, validates whether required controls are functioning, and provides objective reporting and recommendations without assuming routine ownership of Service Coordination production. The position is based in Pennsylvania and requires the ability to attend onsite meetings in Philadelphia and Harrisburg as needed. For remote or hybrid work, a reliable high-speed internet connection of at least 50 Mbps download and 5 Mbps upload is required. AmeriHealth Caritas is a mission-driven health care organization headquartered in Newtown Square, with more than 30 years of experience. It delivers comprehensive, outcomes-driven care, including integrated managed care products, pharmacy benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Requirements

Bachelor’s degree required.
Seven or more years of progressive experience in Medicaid managed care, LTSS, HCBS, compliance, quality, audit, regulatory operations, or Service Coordination, including leadership experience.
Knowledge of Pennsylvania CHC, HCBS, Medicaid, and LTSS requirements.
Experience with control testing, audit readiness, corrective-action governance, and root-cause analysis.
Skills in data interpretation, risk-based monitoring, executive reporting, and effective challenge.
Proficiency in Tableau, Excel, Databricks, and the MS Office Suite.
Must live in Pennsylvania and be able to attend onsite meetings in Philadelphia and Harrisburg as needed.
For remote or hybrid work, must have reliable high-speed internet with minimum bandwidth of 50 Mbps download and 5 Mbps upload.

Nice To Haves

Master’s degree preferred.

Responsibilities

Develop and maintain a risk-based oversight plan aligned with the CHC Agreement, OLTL guidance, internal policies, and performance commitments.
Monitor compliance, participant-impacting risks, documentation quality, timeliness, staffing controls, and operational effectiveness.
Coordinate readiness for OLTL reviews, audits, monitoring activities, and corrective-action validation.
Analyze findings, root causes, recurring risks, and control gaps, and escalate material concerns.
Track remediation and validate that corrective actions are implemented, sustained, and effective.
Produce executive oversight reports and partner with Compliance, Quality, Regulatory Affairs, Clinical, Utilization Management, Reporting, and Operations.
Recommend policy, process, training, reporting, or system changes based on identified systemic needs.