Health Plan Operations Manager

Career Center•Dallas, TX

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 residing 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. 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 functions to achieve facility-level engagement goals. The role supports facility implementation projects, helps partners execute the plan’s Model of Care, and seeks to reduce total cost of care while improving members’ health and healthcare experience. The manager communicates implementation progress and key performance indicators, identifies barriers, coordinates cross-functional resources, and develops mitigation plans to maximize enrollment. The position also provides customer feedback to internal teams and must comply with all applicable requirements.

Requirements

At least 3 years of experience in a healthcare or managed-care organization, with a demonstrated 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 healthcare 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 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, Local Care Delivery, and Care Management.
Build and sustain facility-level relationships based on mutual benefit, 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 to desired facility outcomes and facilitate results-driven solutions.
Manage cross-functional communications, activities, and events related to facility implementation projects, delivering 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 to inform business decisions and help AHP provide value to members and clients.
Maintain thorough knowledge of AHP products and services.
Communicate business objectives and implementation technical 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 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.