Medical Network Development Specialist

7 days ago


Greenville, North Carolina, United States AmeriHealth Caritas Full time

Job Title: Medical Network Development Specialist

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About Us:

AmeriHealth Caritas is a mission-driven organization with over 30 years of experience delivering comprehensive, outcomes-driven care to those who need it most.

We are committed to helping people get care, stay well, and build healthy communities. Our integrated managed care products, pharmaceutical benefit management, and specialty pharmacy services enable us to provide holistic support to our members.

Estimated Salary: $80,000 - $110,000 per year, depending on experience

Job Description:

The Medical Network Development Specialist plays a critical role in bridging the health plan and its provider network in Eastern North Carolina. This position emphasizes building and maintaining strong provider relationships, ensuring contractual compliance, driving performance improvements, and managing high-impact accounts.

Main Responsibilities:

  • Lead provider education sessions to ensure compliance with state and federal mandates
  • Resolve issues related to network accessibility, quality management, and credentialing
  • Collaborate with internal teams to optimize outcomes for members and enhance provider satisfaction
  • Analyze performance metrics and implement improvement plans to achieve measurable results

Requirements:

  • Bachelor's degree or equivalent education and experience
  • 5-10 years of experience in managed care or health insurance, with expertise in Medicaid, Medicare, and/or ACA Exchange programs
  • Proven success managing provider network value-based contracts and high-dollar, multi-specialty practices
  • Strong background in quality management, including credentialing, re-credentialing, investigating complaints, and addressing quality issues

Benefits:

  • Flexible work solutions, including remote options and hybrid work schedules
  • Competitive pay and benefits package, including health insurance coverage for you and your dependents on Day 1
  • Tuition reimbursement and professional development opportunities

Diversity, Equity, and Inclusion:

AmeriHealth Caritas is committed to creating an inclusive and equitable workplace where everyone feels valued and supported. We celebrate and embrace diverse thoughts and perspectives to drive innovation and excellence in our work.

Career Opportunities:

We offer a range of career paths and opportunities for growth and development. If you are passionate about making a difference in the lives of others, we encourage you to explore our current job openings and learn more about our company culture and values.



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