Working under the general direction of the Chief Medical Officer, this individual will be responsible for assessing insurance market trends, emerging payment models and related factors affecting the insurance industry and impacting health care costs. This individual is responsible for overseeing association work that highlights member activities to improve access to care, quality and patient experience.
Works with CMS leadership on strategic quality of care and payment and delivery reform issues including Core Quality Measures Collaborative (CQMC), MA and QHP quality ratings, MACRA and other public programs
Leads response to federal regulations pertaining to quality, payment and delivery system reform, NCQA HEDIS and health plan accreditation standards etc.
Initiates planning and strategy around quality measurement including NQF and MAP.
Coordinates AHIP’s representation on quality-related boards NCAQ HEDIS, URAC and CQMC, etc.
Builds consensus and relationships with internal and external stakeholders
Assesses requests for participation in activities of various external stakeholder organizations and works with staff and members to respond appropriately
Serves as liaison to health plan decision makers regarding new payment and delivery models and research on AHIP’s strategic plan and other industry priorities
Monitors and tracks CMMI activity and progress on Medicare payment reform
Participates on the CMMI Learning Action Network (LAN) Guiding Committee
Working with the Chief Medical Officer, recommends research initiatives to address strategic priorities established by the Board
Advises AHIP and member plan staff on key quantitative and qualitative studies that advance the awareness and recognition of member efforts on market changes and improvement in the delivery and outcomes of care
Develops effective communication approaches to disseminate research on member health plan value including peer-reviewed publications, blog posts etc.
Represents industry to key external organizations and through presentations that highlights industry value and leadership
Other activities as assigned that advance private market innovation and provider engagement and improvement
Performs other duties as assigned
Supervises health policy staff to assure goals and timelines are met.
Extensive knowledge of health insurance, health care financing and policy, and policy research issues
Extensive knowledge of the environmental and industry-wide factors affecting healthcare costs and payment reform.
Extensive knowledge of value based payment models and alternative payment methodologies such as ACO, PCMH, CPC+ and others.
Knowledge of healthcare related legislation including ACA, CHIP and MACRA
Knowledge of structure and functioning of federal health care financing and policy issues, especially Congressional and federal support agencies (Congressional Budget Office, MedPAC, Government Accountability Office), CMS, CMMI and other federal agencies, organizations, and think tanks that conduct research and policy analyses that impact the health insurance sector
In-depth knowledge of quality measurement in healthcare especially as it relates to health plans.
Familiarity with the insurance industry and payment models including commercial plans, Medicare Advantage and Medicaid
Ability to interact with top public officials and academic researchers on behalf of AHIP.
A track record of effectively managing professional staff and providing staff development
Strong organizational skills and an ability to work independently and use good judgment with regard to institutional policies and priority deadlines
Strong interpersonal skills with ability to work cooperatively to achieve overall organizational goals
Excellent oral and written communication skills
Ability to work effectively in and to lead multi-disciplinary teams
At least 10 – 12 years of experience in health care quality measurement and reporting
Minimum of ten years of experience in value-based purchasing models or alternative payment models
Minimum five years of experience in a senior executive position
Minimum ten years of experience in management of staff
Previous experience with membership-driven organizations is helpful
Master’s degree in Economics, Healthcare Policy, Public Health, or related degree
Certification Requirements: None
Physical Work Activities & Conditions:
Continuous sitting for prolonged periods more than 2 consecutive hours in an 8-hour day.
Keyboard use of greater or equal to 50% of the workday.
Percent of Travel:
The purpose of a job description is to describe the overall function and general responsibilities of a job. Job descriptions are used in hiring and training and to provide employees with a better understanding of employer expectations. Actual job functions and duties will vary as job responsibilities and business needs require.
Equal Opportunity Employer
America’s Health Insurance Plans (AHIP) is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, age, disability, religion, sex, sexual orientation, gender identity, national origin, or status as a protected veteran.
Interested candidates are requested to visit AHIP’s Career Website for further instructions on resume submission.
How to Apply
Equal Opportunity Employer M/F/D/V
AHIP is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, age, disability, religion, sex, sexual orientation, gender identity, national origin, or status as a protected veteran.
In order to request consideration for an opened position at AHIP, all candidates must complete an AHIP Job Application and submit it, along with a current resume and cover letter that includes your requested salary range. We also ask that you complete and return the three voluntary forms that aid us in our attempt to meet our affirmative action goals:
All voluntary documents will be used for Affirmative Action tracking purposes only, and will be held confidentially in our Human Resources Department. They will not be viewed during the hiring process.
Once completed, all forms should be returned to our recruitment mail box at: firstname.lastname@example.org or mail to:
America’s Health Insurance Plans (AHIP) ATTN: HR Dept/CASVPPMI 601 Pennsylvania Avenue, NW South Building, Suite 500 Washington, DC 20004
Additional Salary Information: Salary is commensurate with experience
America’s Health Insurance Plans (AHIP) is the national trade association representing the health insurance community. AHIP’s members provide health and supplemental benefits through employer-sponsored coverage, the individual insurance market, and public programs such as Medicare and Medicaid. AHIP advocates for public policies that expand access to affordable health care coverage to all Americans through a competitive marketplace that fosters choice, quality, and innovation.