AVP, CHC Operations

Why Choose Jefferson Health Plans?

We are an award-winning, not-for-profit health maintenance organization offering Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) plans that include special benefits to improve the health and wellness of our members. We are committed to creating a community where everyone belongs, acknowledges, and celebrates diversity and has opportunities to grow to their fullest potential.

While this job currently provides a flexible remote option, due to in-office meetings, training as required, or other business needs, our employees are to be residents of PA or the nearby states of DE or NJ.

Perks of JHP and why you will love it here:

• Competitive Compensation Packages, including 401(k) Savings Plan with Company Match and Profit Sharing 
• Flextime and Work-at-Home Options
• Benefits & Wellness Program including generous Time Off 
• Impact on the communities we service 

We are seeking a talented and enthusiastic AVP, CHC Operations to join our team!

The AVP, CHC Operations is responsible for and oversees all LTSS.  This position provides leadership and oversight for the CHC provider network, direct care workforce support, electronic visit verification, and support functions, including employment, housing, assistive technology, self-direction, and contract compliance.  The  AVP, CHC Operations leads or supports program design, implementation, contract compliance, and financial performance. They are responsible for maintaining positive working relationships with external parties active in the LTSS space, including provider associations, community-based organizations, fellow CHC-MCOs, and regulators.

As the AVP, CHC Operations, your daily duties may include: 

•    Able to work in a constant state of alertness and safe manner.
•    Manage the program on a day-to-day basis to achieve annual plans, financial goals, and strategic objectives.
•    Ensure program design, contract and other requirements get reviewed and updated as appropriate based on contractual and regulatory changes.
•    Foster collaboration initiatives to minimize provider abrasion. 
•    Work across the health plan operating areas to develop and continually monitor appropriate Service Level Agreements for operational areas and coordination protocols for other departments including and Claims, SIU, and Participant Services.
•    Establish and maintain relationships with external parties that support successful LTSS performance including, but not limited to, advocacy groups, community organizations, nursing facilities, HCBS providers, and regulatory agencies.
•    Routinely evaluate performance and continuously modify business approaches to improve performance.
•    Maintain awareness of both the external and internal competitive landscape and recommend program enhancements, as warranted.
•    Stay current with all pertinent regulatory and compliance requirements including but not limited to CMS, DHS, and OLTL.
•    Conduct self in accordance with HPP code of conduct; ensure entire department also follows HPP corporate wide policies and procedures.
•    Perform other duties as assigned.

 
Qualifications   
•    Bachelor’s degree required and master's degree in relevant discipline preferred.
•    Five years’ experience administering LTSS programs required.
•    Minimum of 5 years’ relevant management experience required.
•    Project management, administration, or operations experience in the health care industry preferred.

 Skills, We Value: 
•    Broad knowledge of DHS regulations as they relate to service coordination or case management required. 
•    Excellent oral and written communication skills.
•    Excellent organizational performance and achievement of goals. 
•    Capable of individual initiative, self-starter. 
•    Computer skills necessary with emphasis on Microsoft Office and Database applications. 
•    Excellent interpersonal and communications skills. 
•    Strong independent decision-making skills. 
•    Strong influencing, negotiation, conflict resolution and analytical skills preferred.
•    Demonstrated expertise in managing direct reports and cross functional relationships.
•    Strong project management and organizational skills.
•    Knowledgeable with respect to all aspects of LTSS
•    Experienced in managing to the bottom line, including development and management of budgets.