Health Plan Operations Manager

American Health Communities; Ashland (KY); On-site; USD 80,000 - 110,000; Full time

Benefits offered by this job

Health insurance

Paid time off

TeleDoc 24/7/365 access

Disability plans (short-term and long)

EAP

401K retirement accounts

Employee Referral Bonus Program

Job summary

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., operates Institutional Special Needs Plans (I-SNPs) for seniors in long-term care facilities. It partners with nursing home operators to reduce ER visits and avoidable hospitalizations, with expansion planned to additional states in 2026.

The role involves implementing engagement strategies and coordinating with multiple health-plan functions to meet facility goals.

Qualifications

• 3+ years of experience in health care / managed care organization with demonstrated leadership of teams.
• Experience with value-based and risk-based negotiating arrangements.
• Proven ability to build relationships with external executives and stakeholders and persuade.

Responsibilities

• Drive Participating SNF Engagement and collaboration with partner facilities to support plan goals.
• Collaborate cross-functionally with local health plan, Network, Market Medical Director and Marketing.
• Track implementation progress, manage data repository, and ensure documentation is up to date.
• Create mitigation plans to maximize enrollment and ensure on-time delivery of projects.
• Ensure compliance with all requirements and deliver high-quality implementations.

Skills

Healthcare experience

Team leadership

Value-based contracting

Job description

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. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, Mississippi, Iowa, Louisiana, Pennsylvania, Iowa, Indiana, and Idaho with planned expansion into other states in 2026. For more information, visit AmHealthPlans.com.

Benefits and Perks include:

• Affordable Medical/Dental/Vision insurance options
• Generous paid time-off program and paid holidays for full time staff
• TeleDoc 24/7/365 access to doctors
• Optional short- and long-term disability plans
• Employee Assistance Plan (EAP)
• 401K retirement accounts
• Employee Referral Bonus Program
• Implements and executes the Participating SNF Engagement strategy; establishes strong, collaborative relationships with partner facilities in support of health plan goals.
• Responsible for working cross-organizationally with local health plan team, Network, Market Medical Director and Marketing as needed.
• Responsible for achieving facility-level engagement goals.
• Actively collaborates with all health-plan functions (Product, Sales, Marketing, Member Experience, Finance, Network, Clinical, Quality, Operations and Local Care Delivery and Care Management).
• Cultivates and sustains effective facility-level relationships built on mutual benefit, implementing solutions which position facilities for success executing plan's Model of Care, reducing the total cost of care and improving the health and healthcare experience of members.
• Communicates key performance indicators to participating facilities.
• Identifies challenges and barriers that may prevent facilities from meeting desired outcomes and facilitates results-driven solutions.
• Manages cross-functional communication, activities and events related to facility implementation projects to deliver products on schedule, within budget and with superior quality. Ensures the appropriate cross-functional resources are involved at all phases of facility implementation.
• Understands the clients’ business needs, culture and workflows to identify and serve as the expert in making business decisions that enable AHP to provide the fullest value to its members and clients. Thorough knowledge and understanding of AHP products and services.
• Communicate business objectives as well as technical complexities of implementation to key stakeholders at all levels of AHP and clients.
• Track, report and communicate implementation progress to team members and stakeholders; manage implementation data repository and ensure all implementation documentation is up to date and accessible.
• Create mitigation plans as needed throughout implementation phases to maximize enrollment.
• Provide transparency for project status and delivery across AHP and Client stakeholders.
• Provide customer feedback to Business Development, Network, Sales, Operations, Clinical, Local Market and other key internal teams regarding implementation requests and product enhancements.
• Must adhere to all compliance requirements.

Required Qualifications:

• 3+ years of experience in health care / managed care organization with demonstrated track record of increasing responsibility and accountability to include leading and facilitating teams.
• Experience with value base and risk-based negotiating arrangements.
• Demonstrated success building relationships with external executives and stakeholders; possesses a strong ability to persuade.

Preferred Qualifications:

• Experience with Medicare Advantage or Institutional Special Needs Plans is highly preferred.
• 5+ years in the health care industry with experience in Medicare, Medicaid Managed Care, Health Insurance or Nursing home industry.
• 3+ Experience working with/in Nursing Homes.

EQUAL OPPORTUNITY EMPLOYER

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 for an accommodation be made.

This employer participates in E-Verify.

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.