Manager Provider Network Management

Job Title

Responsibilities :

Responsible for managing the day-to-day activities of the Network Management department and staff. Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. This position is also responsible for all provider network recruiting and contracting management activities. Ensures that the department and staff remain current in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes. Ensures department achieves annual goals and objectives.

Contracting

• Responsible for hospital and physician network development and management.
• Develops and recommends policy changes related to provider recruitment and contracting.
• Recruits and negotiates contracts with specific providers within operational and potential new counties to meet company requirements.
• Oversees training and communication for network providers and acts as a liaison with the provider community.
• Ensures compliance with pricing guidelines established by AMC and Plan.
• Ensures provider contracting is consistent with claim payment methodologies.
• Maintains familiarity with State Medicaid fee schedules and analyzes comparable Plan pricing guidelines.
• Resolves difficult complex contract issues to ensure that provider contracts are in compliance with state, federal, national accrediting agencies and Plan contracting guidelines.
• Ensures that non-standard contract elements are communicated to appropriate departments and obtains AMFC and Plan approval prior to submission to provider.
• Responsible for the accuracy and timely management of all provider contracts.
• Responsible for implementation of electronic strategies for provider network to include increasing electronic claims submission and implementation of improved processes that result in increased auto-adjudication of claims.

Work Arrangement

This position is a hybrid position, working in the office 4 days / week. Office is located at 1201 Maine SW.

Recruitment

General Administrative Activities

Education / Experience :

The targeted hiring range for this role is expected to be between $102,700 and $140,000.

Your career starts now. We're looking for the next generation of health care leaders. At AmeriHealth Caritas, we're passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we'd like to hear from you.

Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, competitive pay, paid time off including holidays and volunteer events, health insurance coverage for you and your dependents on Day 1, 401(k) tuition reimbursement and more.

The range displayed in this job posting reflects the minimum and maximum for new hire salaries for the position in the D.C. office. Within the range, individual pay is determined by additional factors, including, without limitation, job-related skills, experience, and relevant education, certifications, or training.

AmeriHealth Caritas associates are eligible to participate in our annual incentive program and will also receive our benefits package, consisting of medical, vision, dental, life insurance, disability insurance, 401(k), paid time off and more.

The targeted hiring range for this role is expected to be between $102,700 and $140,000.