Provider Network Management Specialist

Amerihealth Caritas•Washington, DC

5d•$71,600 - $97,500•Hybrid

About The Position

The Provider Network Management Specialist develops strong relationships with providers to support performance, particularly among program-designated core providers in fee-for-service programs. These providers may include primary care physicians, OB/GYNs, high-volume specialists, and federally qualified health centers. The role supports network development and management, provider satisfaction, education, and communication, and helps maintain productive relationships between the health plan and contracted providers. The position serves assigned provider accounts, which may include one or more practices, locations, integrated delivery systems, or other provider organizations. It uses data to improve provider relationships, resolves provider disputes, conducts site visits as needed, and maintains accurate provider database information. The specialist also supports provider recruitment where network adequacy gaps are identified, contracting across multiple product lines, and value-based care relationships and negotiations as needed. This is a hybrid position based in the Washington, D.C. office, with an arrangement of four days per week. The targeted hiring range is $71,600 to $97,500. The role requires access to reliable high-speed internet for hybrid work, with minimum bandwidth of 50 Mbps download and 5 Mbps upload.

Requirements

Associate's degree or at least one year of experience as an Account Executive.
Strong communication skills, including the ability to deliver provider education, training, and onboarding to large groups.

Nice To Haves

Bachelor's degree preferred.

Responsibilities

Support network development and network management strategies.
Assist the Leader with departmental activities related to provider satisfaction, education, and communication.
Assist with same case agreement strategy.
Build, nurture, and maintain positive working relationships between the health plan and contracted providers.
Resolve provider disputes in a timely and compliant manner.
Service assigned provider accounts, which may include single or multiple practices, locations, integrated delivery systems, or other provider organizations.
Use data to develop and implement methods to improve provider relationships.
Perform site visits as needed.
Maintain working knowledge of the provider database and relay information about additions, deletions, or corrections.
Identify and maintain strong partnerships with appropriate internal resources and stakeholders.
Maintain operational knowledge related to provider satisfaction, education, and communication, including claims, payment integrity, provider data, credentialing, and appeals and disputes.
Maintain an in-depth understanding of plan contracts, provider performance, and provider needs.
Identify and conduct relevant, tailored provider orientation sessions and educational visits, and work to resolve provider issues.
Assist with recruiting providers based on identified network adequacy gaps, including high-complexity gaps.
Support contracting for multiple product lines, including LTSS, Exchange, and DSNP, and potentially complete straightforward fee-for-service contracts.
Support value-based care relationships and negotiations where needed.