Health Plan Operations Manager

Career Center•Indianapolis, IN

15h

About The Position

American Health Plans, a division of American Health Partners Inc., owns and operates Institutional Special Needs Plans (I-SNPs) for seniors living in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care, reducing emergency room visits, and avoiding preventable hospitalizations. The division operates in multiple states and plans to expand into additional states in 2026. The Health Plan Operations Manager implements and executes the Participating SNF Engagement strategy and builds collaborative relationships with partner facilities to support health plan goals. The role works across organizational teams and with external facility stakeholders to support the plan’s Model of Care, improve member health and healthcare experience, and reduce total cost of care. It also manages cross-functional facility implementation projects, monitors progress and performance, communicates with stakeholders, and helps address barriers to successful outcomes. The position must adhere to all compliance requirements.

Requirements

At least 3 years of experience in a health care or managed care organization, with a demonstrated track record of increasing responsibility and accountability, including leading and facilitating teams.
Experience with value-based and risk-based negotiating arrangements.
Demonstrated success building relationships with external executives and stakeholders.
Strong ability to persuade.

Nice To Haves

Experience with Medicare Advantage or Institutional Special Needs Plans is highly preferred.
At least 5 years in the health care industry, with experience in Medicare, Medicaid Managed Care, health insurance, or the nursing home industry.
At least 3 years of experience working with or in nursing homes.

Responsibilities

Implement and execute the Participating SNF Engagement strategy and establish collaborative relationships with partner facilities.
Work cross-organizationally with the local health plan team, Network, Market Medical Director, Marketing, and other relevant teams.
Achieve facility-level engagement goals.
Collaborate with health-plan functions including Product, Sales, Marketing, Member Experience, Finance, Network, Clinical, Quality, Operations, and Local Care Delivery and Care Management.
Build and sustain facility-level relationships and implement solutions that support facilities in executing the plan’s Model of Care, reducing total cost of care, and improving members’ health and healthcare experience.
Communicate key performance indicators to participating facilities.
Identify challenges and barriers to desired facility outcomes and facilitate results-driven solutions.
Manage cross-functional communication, activities, and events related to facility implementation projects to deliver products on schedule, within budget, and with superior quality.
Ensure appropriate cross-functional resources are involved throughout all phases of facility implementation.
Understand clients’ business needs, culture, and workflows and use that knowledge to support business decisions that enable AHP to provide value to members and clients.
Maintain thorough knowledge and understanding of AHP products and services.
Communicate business objectives and technical implementation complexities to stakeholders at all levels of AHP and client organizations.
Track, report, and communicate implementation progress to team members and stakeholders.
Manage the implementation data repository and keep implementation documentation up to date and accessible.
Create mitigation plans as needed during implementation to maximize enrollment.
Provide transparency regarding project status and delivery across AHP and client stakeholders.
Share customer feedback with Business Development, Network, Sales, Operations, Clinical, Local Market, and other internal teams regarding implementation requests and product enhancements.
Adhere to all compliance requirements.