Manager Provider Network Management

About the job:

The Manager of Provider Network Management manages the Network Management department's and staff's day-to-day activities.; Responsible for assisting the leader with departmental activities related to provider satisfaction, education, and communication. This position is also responsible for all provider network recruiting and contracting management activities by ensuring that the department and staff remain current in all aspects of federal and state rules, regulations, policies, and procedures; creates or modifies departmental policies to reflect changes and ensures the department achieves annual goals and objectives.

Responsibilities:

• Assist leader with driving network management strategy.;

• Responsible for assisting the leader with departmental activities related to provider satisfaction, education and communication.;

• Responsible for assisting in the development and execution of annual provider network strategy to include network adequacy standards, as well as a marketable network.;

• Implement and oversee market strategies.;

• Responsible for staffing decisions and managing the day-to-day activities of the Account Executives, Quality Practice Advisors and Provider Network Coordinators.;

• Assist department leader to ensure department staff remains compliant in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes.;

• Oversight and resolution of provider disputes.;

• Oversees training and communication for network providers and acts as a liaison with the provider community.;

• Establishes a priority list of new geographical locations and types of providers to be added to the Plan network in alignment with Plan departments.;

• Works with Plan departments to retain network providers at risk for termination. ; Develops and executes plan for large scale provider terminations.;

• Participates in Plan and physician committees as appropriate. ;

• As applicable, strategic planning of facility and physician network value based contracting development and management. ;

• As applicable, assists territory Account Executives with planning, implementing and monitoring value-based programs. ;

• Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan's territory.;

• Develop / assist in development of provider trainings and communications. ;

• General operational knowledge related to provider satisfaction, education and communication.;

• Support Value Based contract negotiations; lead negotiator where needed;

• Other duties assigned;

Education & Qualifications:

• A bachelor's degree required in business or a health-related discipline, such as healthcare administration

• healthcare management or equivalent education and business experience is required.

• 2 to 3 years of Medicaid experience is required.

• 1 to 3 years managing health insurance, Medicaid Business.

• 5 years of provider contracting/reimbursement experience in a healthcare setting.

• 3 years of supervisory/management/leadership experience, preferably in a managed care organization setting.

• Must be able to communicate effectively with the leadership and team members.

• The candidate must be in South Carolina and have a valid driver's license and car insurance.

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Our Comprehensive Benefits Package

Flexible work solutions include remote options, hybrid work schedules, competitive pay, paid time off, holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement, and more.

Your career starts now. We are looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare 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. If you want to make a difference, we would like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 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.

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As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.