Director Service Coordination & Oversight

Qualified candidates must live in Pennsylvania and be able to attend onsite meetings in Philadelphia and Harrisburg as needed.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas we’re passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. We'd like to hear from you if you want to make a difference. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com. Role Overview The Director Service Coordination Oversight provides independent monitoring and governance of Service Coordination regulatory compliance, operational controls, quality performance, and corrective action effectiveness. Identifies systemic risk, validates whether required controls are functioning, and provides objective reporting and recommendations without assuming routine ownership of Service Coordination production.

Responsibilities:

• Develop and maintain a risk-based oversight plan aligned with the CHC (Community Health Choices) Agreement, OLTL (Office of Long Term Living) guidance, internal policies, and performance commitments.
• Monitor compliance, participant-impacting risks, documentation quality, timeliness, staffing controls, and operational effectiveness.
• Coordinate readiness for OLTL reviews, audits, monitoring activities, and corrective action validation.
• Analyze findings, root causes, recurring risks, and control gaps and escalate material concerns.
• Track remediation and validate that corrective actions are implemented, sustained, and effective.
• Produce executive oversight reports and partner with Compliance, Quality, Regulatory Affairs, Clinical, UM (Utilization Management), Reporting, and Operations.
• Recommend policy, process, training, reporting, or system changes based on identified systemic needs.

Education/Experience:

• Bachelor’s Degree required
• Master's Degree preferred
• 7 or more years of progressive experience in Medicaid managed care, LTSS (Long-Term Services and Supports), HCBS (Home- and Community-Based Services), compliance, quality, audit, regulatory operations, or Service Coordination, including leadership experience.

Skills & Abilities

• Knowledge of Pennsylvania CHC, HCBS, Medicaid, and LTSS requirements
• Control testing, audit readiness, corrective action governance, and root-cause analysis.
• Data interpretation, risk-based monitoring, executive reporting, and effective challenge.
• Proficient in Tableau, Excel, Databricks, MS Office Suite.

Work Arrangement:

• Must live in Pennsylvania and be able to attend onsite meetings in Philadelphia and Harrisburg as needed.

Our Comprehensive Benefits Package Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.