Executive Director of Health Plan Operations

Executive Director of Health Plan Operations

American Health Plans, a division of Franklin, Tennessee‑based American Health Partners Inc., owns and operates Institutional Special Needs Plans (I‑SNPs) for seniors who reside 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 currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Idaho, and Iowa with planned expansion into other states in 2024.

The Executive Director is accountable for health plan success within a given market, with primary responsibility for leading local initiatives to achieve Member Engagement, Quality, Coding, Affordability, Growth, and Retention goals. Sets strategy and prioritization in accord with corporate goals specific to the local market and ensures cross‑organizational alignment. Serves as the executive representative in the market, engaging new facilities with initial education and goal setting, establishing clear leadership credibility and partnership with external provider and broker partners.

Collaborates on products and solutions that help carry out the mission to improve patient outcomes. Is externally focused and facing.

• Implements and executes the Provider Partner Engagement strategy; establishes strong, collaborative relationships with provider partners in support of all Quality, Collaboration, and Affordability goals.
• Works cross‑organizationally with the local health plan team, Network, Market Medical Director, and Marketing.
• Executes the Growth and Retention strategy in partnership with Sales and Marketing; serves as the face of the market to external channels.
• Achieves market‑level engagement goals and builds market share based on objectives.
• Collaborates with all Plan functions (Product, Sales, Marketing, Member Experience, Finance, Network, Clinical, Quality, Operations, and Local Care Delivery and Care Management) to leverage local market knowledge and drive plans across all levers of the P&L.
• Cultivates and sustains effective executive‑level relationships with Provider Business Partners, implementing solutions that position providers for success, executing the plan’s Model of Care, reducing the total cost of care, and improving the health and healthcare experience of members.
• Monitors, interprets, and presents analytic reports on cost, quality, utilization, patient experience, and risk adjustment at the entity/location level and in aggregate.
• Identifies challenges and barriers preventing provider partners from meeting desired outcomes and facilitates results‑driven, solution‑focused discussions to achieve success.

• Bachelor’s degree required with emphasis in business, marketing, economics, health, or public policy preferred;
  Master’s degree would be a plus.
• 3+ years of experience in health care / managed care organization with a demonstrated track record of increasing responsibility and accountability, including leading and facilitating teams.
• Experience in a Medicare Advantage or other government‑funded healthcare business highly preferred.
• Experience with value‑based and risk‑based negotiating arrangements.
• In‑depth experience with health care providers / networks, CMS Quality Programs (Star ratings, HEDIS measures), Part D, and clinical quality.
• Demonstrated strong financial acumen and analytical skills.
• Strong written and verbal communication skills, including experience developing and delivering concise presentations, and well‑developed interpersonal skills for influencing behavior in a highly matrixed organization.
• Demonstrated success building relationships with external executives and stakeholders; a strong ability to persuade.
• Track record of meeting business goals via disciplined, fact‑based decisions and executing with discipline and urgency.

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request be made. This employer participates in E‑Verify.