Network Contractor Provider Network Management

About the Company

AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience delivering 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. As one of the nation's leaders in health care solutions, we impact the lives of millions through our national footprint and award-winning programs.

About the Role

The primary responsibility of the Network Contractor is contracting and re-contracting providers in an established market. This role supports network development strategy, assists with provider satisfaction, education, and communication, and ensures an adequate, compliant, and marketable network.

Responsibilities

• Support network development strategy and assist the Leader with departmental activities related to provider satisfaction, education, and communication.
• Negotiate contracts to execute on network strategy, ensuring compliance with Federal and State rules, regulations, policies, and procedures.
• Negotiate Single Case Agreements (SCA) rates and convert SCA providers to contracted status.
• Recruit and contract providers based on identified network adequacy gaps (high complexity).
• Ensure contracts support Plan quality initiatives such as HEDIS, CAHPS, and NCQA/URAC.
• Manage provider satisfaction through contract negotiations.
• Work with Corporate Provider Network Management to manage the annual contracting schedule and supplement the network as needed.
• Serve as a subject matter expert (SME) for payment/fee schedules in complex specialties (e.g., FQHCs, behavioral health, anesthesia).
• Develop operational knowledge related to provider satisfaction, education, and communication, including claims, payment integrity, provider data, credentialing, and appeals disputes.
• Negotiate provider contracts consistent with claim payment methodologies.
• Augment and modify the existing provider network to accommodate new products or clients.
• Review contract language and collaborate with legal to ensure optimal contract terms.
• Support contracting for multiple product lines, including Exchange and DSNP.
• Lead negotiator for Value Based Contracting in conjunction with Account Executives.

Requirements

• Associate Degree required; Bachelor's Degree preferred; Master's Degree highly preferred.
• Minimum of three (3) years of Account Executive experience.
• Minimum of one (1) year of contract negotiation experience.

Skills

• Understanding of reimbursement methodologies, including Risk or Value Based contracting.
• Ability to navigate difficult conversations.
• Financial acumen.
• Proficiency using MS Office Suite.

Work Arrangement

This role offers flexible work solutions, including remote and hybrid options. Access to a reliable high-speed internet connection (minimum 50 Mbps download and 5 Mbps upload) is required. Fully remote associates residing in states where service is required by contract, law, or regulation may submit for reimbursement.

Benefits

• Competitive pay.
• Paid time off, including holidays and volunteer events.
• Health insurance coverage for you and your dependents starting on Day 1.
• 401(k) retirement plan.
• Tuition reimbursement.