VP Care Management

Amerihealth Caritas•,

8d•Hybrid

About The Position

The Vice President, Care Management provides executive leadership for the strategy and execution of care management and member engagement outreach. This role leads multidisciplinary teams responsible for coordinating integrated delivery of care across the continuum and aligning outreach strategies to clinical priorities and member needs. In partnership with executive leadership, the VP ensures cohesive direction toward organizational goals, driving measurable improvements in total cost of care, quality outcomes, member engagement, and operational efficiency. The role translates strategy into scalable, standardized execution and leverages data-driven insights and performance metrics to identify opportunities, address complex operational challenges, and deliver high-impact, sustainable results. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Requirements

Bachelor’s Degree.
Registered Nurse.
License must be active and unrestricted in state of practice.
Ten or more years of progressive management experience (including staff management) in a managed care environment.

Nice To Haves

Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM), Certified Professional in Healthcare Quality (CPHQ) or other health care or management certification preferred.
Experience with Managed Medicaid programs highly desirable.
Operational management experience with Case Management and Quality programs.
Demonstrable history of success in managing clinical programs in Medicaid and/or Medicare managed care organizations.
Strong business acumen.

Responsibilities

Provide executive oversight and accountability for the execution of enterprise clinical programs delivered through comprehensive care management and member outreach, targeting members with chronic conditions and emerging risks to drive improved outcomes and total cost of care reduction.
Lead the development and execution of proactive, data-driven care management and engagement strategies, defining processes to optimize interventions, improve member and provider engagement, and ensure delivery of next best actions across populations.
Establish and enforce standardized operating models, workflows, and performance expectations for care management and population health programs across all markets and lines of business, reducing variation and ensuring scalable, consistent execution.
Monitor enterprise performance across lines of business, including cost, quality, and engagement metrics, and ensure timely, data-driven action is taken to address performance gaps in alignment with organizational policies and priorities.
Ensure consistent program implementation, staffing models, and resource alignment across markets, optimizing workforce effectiveness and supporting right-licensure and productivity goals.
Lead and develop a high-performing clinical leadership structure, including Corporate Directors and Market Clinical Directors, to drive accountability, execution, and performance of population health and care management activities.
Ensure compliance with all contractual, regulatory, and accreditation requirements for care management and clinical programs, maintaining readiness for audits and adherence to CMS, NCQA, and state-specific standards.
Oversee the development and application of performance analytics and reporting, leveraging key performance indicators, benchmarks, and analytical insights to evaluate program effectiveness, identify cost drivers, and optimize outcomes.
Drive continuous improvement and operational excellence, implementing process enhancements, decision-support tools, and performance management frameworks to improve efficiency, quality, and cost-effectiveness of care delivery.
Support growth and innovation initiatives, including RFP responses, program design, and evaluation and vetting of new clinical and vendor solutions to ensure alignment with enterprise strategy and value objectives.