Manager, Health Plan Operations

Company Description

You Belong at Albright Life! 

Full-time 

Salary Range:  $85,000 - $95,000 Annually

LIFE (Living Independence for the Elderly) is a Medicare/Medicaid program that helps people meet their healthcare needs in the community instead of going to a nursing home or other care facility. At an Albright LIFE location, you’ll work with a team of healthcare professionals providing exceptional, coordinated services each day that help participants stay healthy and safely live independently at home.

Albright LIFE has a mindset to help others and is a certified Great Place to Work where you can build a purposeful career. Let’s do all the good we can in this world – together! 

Successful candidate must reside in Central, PA.

Job Description

This role presents an extraordinary opportunity for a mission-driven leader to play an integral role in supporting the finance and health plan operations of a dynamic, integrated care delivery program. Responsible for managing and continuously improving our LIFE/PACE Health Plan Operations function, which includes, but is not limited to, TPA management/oversight (claims), utilization management, provider network administration, and more.

Key Responsibilities:

• Lead and improve Health Plan Operations, including claims management, provider network administration, and utilization management.
• Manage relationships with TPAs, PBMs, and other key vendors, resolving issues and overseeing payables/receivables. 
• Support Medicare Part D and Medicaid enrollment processes, tracking data and ensuring regulatory compliance.
• Support government relations and regulatory audits, maintaining reporting for CMS, state requirements, and vendor oversight.
• Support development and refining policies for PACE program compliance, ensuring seamless operations.

Qualifications

• Bachelor’s degree in Healthcare, Finance, or other relevant field of study.
• Strong understanding of health plan and healthcare provider financial funds flows and regulatory requirements, ideally in a PACE, Medicare Advantage (MAPD), or Medicare Prescription Drug Plan (PDP) organization
• Strong expertise in health plan operations, vendor management, and regulatory compliance.
• Excellent leadership, communication, and mentoring skills.
• 3 to 5 years preferred experience of related experience.

Additional Information

Benefits

• Depending upon the status of the position, Asbury offers generous benefits including medical, dental, and vision coverage; 401K with match; PTO and paid holidays

We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.

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