Network Contractor - Provider Network Management (PNM)

Amerihealth Caritas•,

1d•Remote

About The Position

The Network Contractor is responsible for contracting and re-contracting providers in an established market. This remote role requires travel to Louisiana for provider site visits and in-office meetings in Baton Rouge. The contractor supports network development strategy, provider satisfaction, education, and communication, and negotiates contracts that help ensure an adequate, compliant, and marketable provider network. The role includes recruiting and contracting providers to address identified network adequacy gaps, negotiating Single Case Agreement rates and converting those providers to contracted status, and supporting multiple product lines, including Exchange and DSNP. The contractor works with Corporate Provider Network Management on the annual contracting schedule and supplements the network as providers become available or needed. The position also involves reviewing contract language with Legal, supporting value-based contracting with Account Executives, and providing payment and fee-schedule expertise in complex specialties.

Requirements

At least 3 years of Account Executive experience.
At least 1 year of contract negotiation experience.
Understanding of reimbursement methodologies, including risk-based or value-based contracting.
Ability to conduct 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 and ability to collaborate across legal, operations, claims, credentialing, and provider network teams.
Ability to travel to Louisiana for provider site visits and in-office meetings in Baton Rouge.

Nice To Haves

Bachelor's degree preferred.

Responsibilities

Support network development strategy.
Assist the Leader with departmental activities related to provider satisfaction, education, and communication.
Negotiate provider contracts to execute network strategy and ensure an adequate, compliant, and marketable network.
Negotiate Single Case Agreement rates and convert Single Case Agreement providers to contracted status.
Recruit and contract providers to address identified network adequacy gaps, including high-complexity gaps.
Ensure contracts comply with 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 providers become available or are needed.
Develop payment and fee-schedule resources for complex specialties such as FQHCs, behavioral health, and anesthesia, and make this expertise available to Account Executives for claims-resolution support.
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.
Review contract language and collaborate with Legal to secure the best contract terms.
Support contracting for multiple product lines, including Exchange and DSNP.
Lead value-based contract negotiations in conjunction with an Account Executive.