Vice President Plan Operations & Administration

Vice President Of Plan Operations & Administration

Role Overview : The Vice President of Plan Operations & Administration leads operational strategy and execution for the AmeriHealth Caritas Ohio Medicaid plan. Acting as the primary partner to the Market President, this role ensures alignment with enterprise strategic objectives, contractual obligations, and stakeholder priorities. Serving as second-in-command, the VP oversees all aspects of plan infrastructure, driving operational excellence and compliance through collaboration with shared service teams.

Work Arrangement : Hybrid The associate must be in the office at least three days per week at our Dublin, Ohio (OH) location.

Responsibilities :

• Ensure compliance with state program contractual and regulatory requirements, including benefit / payment rules, data submissions, and service-level standards.
• Collaborate with shared services to resolve operational issues through root cause analysis and timely implementation of solutions.
• Monitor performance metrics and process improvements, serving as liaison between the health plan and enterprise functions.
• Partner with Service Operations on major changes and enterprise initiatives.
• Lead cross-functional meetings to foster alignment and coordination across plan and shared services.
• Develop action plans for operational efficiency and cost containment in partnership with Finance and Clinical leadership.
• Assess and mitigate plan-specific risks in collaboration with the Enterprise Risk Management team.
• Represent the Vista Delegation Oversight Committee, ensuring timely updates and compliance.
• Provide day-to-day leadership for Provider Network Operations, Community Engagement & Outreach, Regulatory, and Data & Technical Services teams.

Education & Experience : A bachelor's degree is required. Minimum 5 years of experience in Medicaid / Medicare operations with progressive leadership responsibilities. 10 plus years of progressive experience in business, government, or healthcare management. Deep understanding of Medicaid / Medicare operations and benefit administration. Proven ability to navigate complex, matrixed organizations.