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 healthcare 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.

Discover more about us at www.amerihealthcaritas.com.

About this job:

This position will provide comprehensive senior leadership and strategic direction to the market network management teams in developing and maintaining effective, high-performing market networks. Responsible for managing leaders that manage and contract all hospital, physician, ancillary, facility, and physician extender network development and management for all products in the market. This position is also responsible for coordination and collaboration to align with enterprise objectives to improve provider partnerships and satisfaction. This position will interact with high-volume hospital and physician practice chief executive officers, chief financial officers, directors of managed care, other high-level executives, and AmeriHealth Caritas’s executive leadership.

Responsibilities:

• Leads comprehensive provider contracting strategy to achieve cost-efficient and high-performing network
• Lead development and execution of provider engagement model to drive market leading provider satisfaction
• Ensure strong financial performance by identifying cost-saving opportunities, ensuring competitive provider contracts, and enhancing value-based care.
• Drives member outcome improvement  on top priority quality measures through partnership with & incentives for providers.
• Ensure strategic alignment with state Medicaid agenda and compliance with provider related aspects of state contract.
• Leads and manages provider network team to ensure high performance, accountability, empowerment & engagement.

Education & Qualifications:

• A bachelor’s degree in Business or health-related disciplines such as Healthcare Administration or Healthcare Management or equivalent business experience.
• Master’s Degree preferred.
• 10 or more years of experience years of managed care provider contracting and reimbursement experience, including in-depth knowledge of reimbursement methodologies and contracting terms
• 1 to 2 years of Medicaid experience preferred.
• Minimum 8 to 10 years of progressive business management and negotiation experience.
• Minimum 5 years of management experience, managing teams and project management.
• Travel as needed and in-person provider visits will be required.  

Our Comprehensive Benefits Package

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