Manager Provider Network Management

Amerihealth Caritas Health Plan•Newark, DE

64d•Remote

About The Position

As the Manager of Provider Network, you will build and nurture strategic provider partnerships that strengthen our network, drive innovation, and ensure high-quality care for our communities. They will develop and manage all hospital, physician, and 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. Work Arrangement: Remote with required travel within the state of Delaware.

Requirements

A bachelor's degree in business or health-related disciplines, such as healthcare administration or healthcare management, and equivalent business experience is preferred.
A minimum of 3 years of experience in managed care provider contracting and reimbursement is required, including in-depth knowledge of reimbursement methodologies and contracting terms.
A minimum of 1 to 2 years of Medicaid experience is preferred.
A minimum of three (3) to five (5) years of progressive business management and negotiation experience is preferred.
A minimum of two (2) years of management experience, managing teams, and project management is preferred.
A valid Driver's License and current Auto Insurance are required.

Responsibilities

Lead strategic planning, development, and management of the hospital and physician provider network to meet member needs and ensure network adequacy.
Oversee provider contracting processes, ensuring compliance with pricing guidelines, contract standards, and claim payment methodologies.
Drive implementation of electronic strategies to improve claims submission, auto-adjudication, and operational efficiency.
Ensure departmental compliance with Federal and State regulations, develop policies accordingly, and lead provider communication, education, and satisfaction initiatives.
Supervise, coach, and develop team members to achieve financial, quality, and clinical objectives while fostering innovation, collaboration, and continuous improvement.
Ability to negotiate and develop partnerships with new and existing providers within Delaware.
Partner with state agencies and programs for workforce initiatives for AmeriHealth Delaware Membership.