Health Plan Operations Manager

TruHealth•Fort Worth, TX

About The Position

American Health Plans, a division of American Health Partners Inc., owns and operates Institutional Special Needs Plans (I-SNPs) for seniors residing in long-term care facilities. Working in partnership with nursing home operators, the plans manage medical risk by improving patient care to reduce emergency room visits and avoidable 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, builds collaborative relationships with partner facilities, and works across health-plan and organizational teams to achieve facility-level engagement goals. The role supports facility implementation projects from planning through delivery, tracks progress and documentation, identifies barriers, and develops mitigation plans to maximize enrollment. The manager also communicates performance indicators, implementation status, business objectives, and customer feedback to facility and internal stakeholders. The position must comply with all applicable requirements.

Requirements

At least 3 years of experience in a health care or managed care organization, with 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, with a 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 in support of health plan goals.
Work cross-organizationally with local health plan teams, Network, Market Medical Director, and Marketing as needed.
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 mutually beneficial facility-level relationships and implement solutions that help facilities execute the plan’s Model of Care, reduce total cost of care, and improve members’ health and healthcare experience.
Communicate key performance indicators to participating facilities.
Identify challenges and barriers that may prevent facilities from meeting desired 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 resources are involved throughout implementation.
Understand clients’ business needs, culture, and workflows, and make business decisions that enable AHP to provide value to members and clients.
Communicate business objectives and implementation technical complexities to stakeholders at all levels of AHP and client organizations.
Track, report, and communicate implementation progress; manage the implementation data repository and keep documentation current and accessible.
Create mitigation plans as needed during implementation to maximize enrollment.
Provide transparency regarding project status and delivery across AHP and client stakeholders.
Provide customer feedback to Business Development, Network, Sales, Operations, Clinical, Local Market, and other internal teams regarding implementation requests and product enhancements.
Adhere to all compliance requirements.