Health Plan Operations Manager

American Health Partners•Orlando, FL

28d

About The Position

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Louisiana, Pennsylvania, Iowa, Indiana, and Idaho with planned expansion into other states in 2026. For more information, visit AmHealthPlans.com. If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application!

Requirements

3+ years of experience in health care / managed care organization with demonstrated track record of increasing responsibility and accountability to include leading and facilitating teams.
Experience with value base and risk-based negotiating arrangements.
Demonstrated success building relationships with external executives and stakeholders; possesses a strong ability to persuade.

Nice To Haves

Experience with Medicare Advantage or Institutional Special Needs Plans is highly preferred.
5+ years in the health care industry with experience in Medicare, Medicaid Managed Care, Health Insurance or Nursing home industry.
3+ Experience working with/in Nursing Homes.

Responsibilities

Implements and executes the Participating SNF Engagement strategy; establishes strong, collaborative relationships with partner facilities in support of health plan goals.
Responsible for working cross-organizationally with local health plan team, Network, Market Medical Director and Marketing as needed.
Responsible for achieving facility-level engagement goals.
Actively collaborates with all health-plan functions (Product, Sales, Marketing, Member Experience, Finance, Network, Clinical, Quality, Operations and Local Care Delivery and Care Management).
Cultivates and sustains effective facility-level relationships built on mutual benefit, implementing solutions which position facilities for success executing plan's Model of Care, reducing the total cost of care and improving the health and healthcare experience of members.
Communicates key performance indicators to participating facilities.
Identifies challenges and barriers that may prevent facilities from meeting desired outcomes and facilitates results-driven solutions.
Manages cross-functional communication, activities and events related to facility implementation projects to deliver products on schedule, within budget and with superior quality. Ensures the appropriate cross-functional resources are involved at all phases of facility implementation.
Understands the clients' business needs, culture and workflows to identify and serve as the expert in making business decisions that enable AHP to provide the fullest value to its members and clients. Thorough knowledge and understanding of AHP products and services.
Communicate business objectives as well as technical complexities of implementation to key stakeholders at all levels of AHP and clients.
Track, report and communicate implementation progress to team members and stakeholders; manage implementation data repository and ensure all implementation documentation is up to date and accessible.
Create mitigation plans as needed throughout implementation phases to maximize enrollment.
Provide transparency for project status and delivery across AHP and Client stakeholders.
Provide customer feedback to Business Development, Network, Sales, Operations, Clinical, Local Market and other key internal teams regarding implementation requests and product enhancements.
Must adhere to all compliance requirements.