Network Contractor Provider Network Management (PNM)

Amerihealth Caritas•Baton Rouge, LA

1d•Remote

About The Position

The Network Contractor is primarily responsible for contracting and re-contracting providers in an established market. This remote role requires the associate to reside in Louisiana and attend provider site visits and in-office meetings in Baton Rouge. The position supports network development strategy and works with Corporate Provider Network Management to manage the annual contracting schedule and supplement the network as providers become available or are needed. The role negotiates provider contracts, Single Case Agreement rates, and Value Based Contracting arrangements; recruits providers to address network adequacy gaps; and helps convert Single Case Agreement providers to contracted providers. The Network Contractor also works with internal teams to ensure contracts meet applicable requirements, support plan quality initiatives, and align with claim payment methodologies and network strategy. The role supports multiple product lines, including Exchange and DSNP, and provides subject-matter expertise on payment and fee schedules in complex specialties when needed.

Requirements

Associate’s degree required.
Minimum of 3 years of Account Executive experience.
Minimum of 1 year of contract negotiation experience.
Understanding of reimbursement methodologies, including Risk or Value Based contracting.
Ability to have difficult conversations.
Financial acumen.
Proficiency using the MS Office Suite.
Strong negotiation, persuasion, and conflict-resolution skills.
Knowledge of provider network development, network adequacy, and managed care contracting.
Ability to interpret contract language, reimbursement terms, fee schedules, and regulatory requirements.
Strong analytical, problem-solving, and decision-making skills.
Ability to manage multiple contracting priorities, deadlines, and provider relationships.
Effective written and verbal communication skills, with the ability to collaborate across Legal, Operations, Claims, Credentialing, and Provider Network teams.

Nice To Haves

Bachelor’s degree preferred.
Master’s degree highly preferred.

Responsibilities

Support network development strategy.
Assist the Leader with departmental activities related to provider satisfaction, education, and communication.
Negotiate contracts to execute network strategy and ensure an adequate, compliant, and marketable network.
Negotiate Single Case Agreement (SCA) rates and convert SCA providers to contracted providers.
Recruit and contract providers to address identified network adequacy gaps, including high-complexity gaps.
Ensure contracts comply with applicable Federal and State rules, regulations, policies, and procedures, and follow departmental policies.
Ensure contracts support Plan quality initiatives such as HEDIS, CAHPS, and NCQA/URAC.
Negotiate contracts to support provider satisfaction.
Work with Corporate Provider Network Management to manage the annual contracting schedule and supplement the network as new providers are available or needed.
Develop payment and fee schedule resources as a subject-matter expert in complex specialties, such as FQHCs, behavioral health, and anesthesia, and provide support to Account Executives for claims resolution when needed.
Apply operational knowledge related to provider satisfaction, education, and communication, including claims, payment integrity, provider data, credentialing, and appeals and disputes.
Negotiate provider contracts consistent with claim payment methodologies.
Augment and modify the existing provider network to accommodate new products or clients as necessary.
Review contract language and collaborate with Legal to ensure favorable contract terms.
Support contracting for multiple product lines, including Exchange and DSNP.
Lead Value Based Contracting negotiations in conjunction with the Account Executive.