Washington, D.C.

Nashville, TN


Senior Vice President, Private Market Innovations & Quality Initiatives


November 20, 2017

Position Description

Position:                Senior Vice President, Private Market Innovations & Quality Initiatives

Department:           Clinical Affairs

Employee in Position: * * * Vacant * * *

Reports To:             Chief Medical Officer, AHIP

Scope:                        Full time; Exempt; Permanent

Date:                           November 2017

This position is subject to a pre-employment criminal history background check 

Position Summary

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.

Specific Responsibilities:

  • 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

Supervisory Responsibility:

  • 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
  • PhD preferred

Certification Requirements:

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:

  • 10%

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: hr@ahip.org or mail to:

America’s Health Insurance Plans (AHIP)
601 Pennsylvania Avenue, NW
South Building, Suite 500
Washington, DC 20004