Manager Provider Network Management

Amerihealth Caritas•North Charleston, SC

1d•Remote

About The Position

The Manager of Provider Network Management oversees the day-to-day activities and staff of the Provider Network Management department. The role supports leadership in provider satisfaction, education, and communication, and manages provider network recruitment, contracting, and related activities. The Manager helps ensure the department and its staff comply with applicable federal and state rules, regulations, policies, and procedures, updating departmental policies as needed to reflect regulatory and operational changes. The position also supports the achievement of annual departmental goals and objectives. This role assists with provider network strategy and adequacy, market development, and value-based contracting. It manages department staff, oversees provider disputes and training, serves as a liaison to the provider community, and partners with other Plan departments to maintain provider participation and access to services. The position is remote, and candidates must reside in South Carolina and have a valid driver's license.

Requirements

Bachelor's degree required.
Managed care experience required.
At least 5 years of provider network management, contracting, reimbursement, or other related experience required.
Strong verbal and written communication skills, including the ability to communicate effectively with leadership, team members, providers, and other key stakeholders.
Must reside in South Carolina and possess a valid driver's license.

Nice To Haves

A degree in business, healthcare administration, healthcare management, another health-related discipline, or an equivalent field is preferred.
Medicare, Medicaid, and/or Health Insurance Marketplace/Exchange experience is preferred.
At least 3 years of supervisory, management, or leadership experience is preferred, preferably within a managed care organization.

Responsibilities

Assist leadership with driving provider network management strategy.
Assist leadership with departmental activities related to provider satisfaction, education, and communication.
Assist in developing and executing the annual provider network strategy, including network adequacy standards and development of a marketable provider network.
Implement and oversee market strategies.
Make staffing decisions and manage the day-to-day activities of Account Executives, Quality Practice Advisors, and Provider Network Coordinators.
Assist department leadership in ensuring staff comply with applicable federal and state rules, regulations, policies, and procedures; create or modify departmental policies as needed.
Oversee and facilitate resolution of provider disputes.
Oversee training and communication for network providers and serve as a liaison with the provider community.
Establish priorities for adding geographic locations and provider types to the Plan's network in alignment with other Plan departments.
Partner with Plan departments to retain network providers at risk of termination and develop and execute plans for large-scale provider terminations.
Participate in Plan and physician committees, as appropriate.
As applicable, provide strategic planning for facility and physician network value-based contracting development and management.
As applicable, assist territory Account Executives with planning, implementing, and monitoring value-based programs.
Monitor and manage the provider network to ensure appropriate access to services throughout the Plan's territory.
Develop and assist with developing provider training and communications.
Maintain general operational knowledge related to provider satisfaction, education, and communication.
Support value-based contract negotiations and serve as lead negotiator when needed.