Job Information
AmeriHealth Caritas Director, Contract Performance in Dublin, Ohio
Role Overview: The Director of Contract Performance is responsible for developing systems and tools to sustainably improve key performance metrics, ensure compliance and operational excellence, ensure successful execution of contractual obligations, streamline workflows, improve efficiency and profitability, define reporting requirements, and lead initiatives to address performance gaps, including servicing as the designated lead for the Ohio Department of Medicaid (ODM) contract administration activities.
Work Arrangements:
- Remote – Associate must be in the state of Ohio (OH).
Responsibilities:
Serve as the primary point of contact for operational and contractual matters with ODM executive leadership, including day-to-day MCO operational issues, escalations, and cross-functional coordination, ensuring strong relationships, optimal contract performance, and full compliance with all requirements.
Provide strategic leadership to the Contract team, overseeing intake, triage, coordinator, and response management for ODM operational and contractual inquiries, quality improvement initiatives, performance monitoring, and cross‑functional coordination.
Coordinate the centralized tracking, preparation, validation, and timely submission of all ODM contract deliverables, ensuring accuracy, completeness, and adherence to contractual requirements and timelines.
Lead enterprise and Line of Business (LOB) efforts to develop, implement, and monitor operational processes and performance measures that meet contractual, regulatory, and accreditation standards, including NCQA, HEDIS, and EBIP requirements.
Direct and execute quality, productivity, and performance improvement initiatives, including clinical oversight programs focused on reducing unnecessary utilization and controlling costs.
Partner with executive leadership to develop, communicate, and track progress against annual and multi‑year strategic and business plans.
Oversee audit readiness and execution by coordinating documentation, validating data, preparing reports and presentations, and managing timely and accurate responses to contract audits and external data requests, including random and periodic audits, reviews, and on-site or virtual ODM site visits.
Collaborate with business owners and corporate reporting teams to standardize processes, establish performance metrics, and design scorecards that highlight LOB performance across key operational and quality indicators.
Develop and execute structured transition plans to ensure timely, accurate integration of new contracts, processes, and business strategies into day‑to‑day operations.
Establish and implement short‑ and long‑term departmental objectives aligned with organizational goals, strategic initiatives, and regulatory guidelines.
Oversee departmental planning, budgeting, staffing, policy administration, and resource allocation to ensure alignment with approved financial plans and organizational priorities.
Foster a high‑performing team culture through effective performance management, career development, and clear communication to support departmental and enterprise‑wide goals.
Education & Experience:
Bachelor’s degree required.
5 to 10 years of progressively responsible experience in contract management, healthcare operations, or performance improvement, including proven leadership overseeing cross-functional teams and enterprise-wide initiatives.
Experience working with Medicaid managed care contracts and regulatory environments.
Skills & Abilities:
Demonstrated ability to analyze complex data, develop performance metrics, and translate insights into actionable recommendations.
Excellent communication and relationship-building skills, including the ability to engage effectively with executive leadership and external stakeholders.
Highly organized with strong project management, problem-solving, and decision-making capabilities.
Ability to manage competing priorities in a fast-paced, highly regulated environment.
As a company, we support internal diversity through:
Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.