Director Provider Network Management

Your career starts now. We’re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care 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’d 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.

The Director of Provider Network Management will develop and manage all hospital, physician, and physician extender networks.  This position is also responsible for implementing strategies to improve provider satisfaction and manage network costs.  This position will interact with Hospital and Physician Practice Chief Executive Officers, Chief Financial Officers, Directors of Managed Care, and other high-level executives.  Ensures the department achieves annual goals and objectives.

Roles and Responsibilities:

- Develop and implement strategic plans for hospital and physician network development and management

- Ensure compliance with pricing guidelines established by AmeriHealth Caritas and regulatory bodies

- Oversee contract implementation process for all contracts and ensure provider contracting policies are consistent with claim payment methodologies

- Maintain provider network adequacy standards to meet the healthcare needs of Plan members

- Lead recruitment activities and oversee recruitment efforts of staff to augment and modify the provider network as needed

- Act as a liaison with the designated provider community and ensure provider communication and education meet company needs

- Supervise assigned staff, conduct annual reviews, and provide coaching and support for ongoing growth and knowledge expansion

- Work with and support other teams as necessary to advance the interest of the health plan 

- Drive quality initiatives such as HEDIS, CAHPS, and NCQA/URAC to achieve financial, quality, and clinical objectives

- Develop and ensure compliance with the department budget and participate in Plan and physician committees as appropriate

-Ability to negotiate and develop partnerships with new and existing providers within the state of New Hampshire. 

Education/Experience:

•  A bachelor’s degree in business or health-related disciplines such as healthcare administration or healthcare management is preferred, as well as equivalent business experience.  

• Minimum 3 years of experience in managed care provider contracting and reimbursement is required, including in-depth knowledge of reimbursement methodologies and contracting terms.

• 1 to 2 years of Medicaid experience preferred.

• A minimum of 8 to 10 years of progressive business management and negotiation experience is preferred.

• A minimum of 5 years of management experience, managing teams, and project management is preferred.

• A valid Driver’s License and current Auto Insurance are required.

Diversity, Equity, and Inclusion

At Amerihealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.