Responsibilities:

This position is responsible for all hospital, physician and physician extender network development and management within the state of Florida. This position is also responsible for implementing strategies to improve provider satisfaction. This position will interact with Hospital and Physician Practice Chief Executive Officers, Chief Financial Officers, Directors of Managed Care and other high level executives.  Ensures department achieves annual goals and objectives.

• Oversees strategic planning, development, and management of the hospital, physician, and physician-extender network. Ensures compliance with AMFC/Plan pricing guidelines, contract standards, State and Federal regulations, Medicaid fee schedules, and network adequacy requirements. Manages contract implementation processes and ensures provider contracting aligns with claim payment methodologies.

• Implements strategies to improve provider satisfaction and ensures the network meets member healthcare needs. Maintains strong relationships with hospital and physician executives, resolves provider issues promptly, oversees provider education/communication, and develops plans to address findings from provider satisfaction surveys.

• Leads implementation of electronic strategies, including increasing electronic claims submission and improving auto-adjudication processes. Develops innovative operational improvements, coordinates cross-department activities, manages reports (capitation, rosters, RHC/FQHC), and supports company-wide quality initiatives such as HEDIS, CAHPS, and NCQA/URAC.

• Makes staffing decisions, supervises team members, conducts performance evaluations, and fosters professional growth. Coaches the team in data use, analytical tools, creative problem-solving, technology adoption, and collaborative practices. Ensures staff remain informed on policy, regulatory, and procedural changes.

• Develops and manages the department budget, ensures achievement of financial, quality, and clinical objectives, participates in Plan and physician committees, supports mission and values, coordinates with other departments, and performs additional duties and projects as assigned.
   

Work Arraignment: Remote but reside in the State of Florida and will require travel throughout the entire state.  

Education:

• Bachelor’s degree in Business or health related disciplines such as Healthcare Administration or Healthcare management or equivalent business experience required. 
• Master’s Degree preferred.

Experience: 

• Minimum of 8 to 10 years of progressive  business management and negotiation experience.
• Minimum of  5 years management experience, managing teams and project management.
• Minimum of 3 years Managed Care Provider Contracting and Reimbursement experience to include in depth knowledge of reimbursement methodologies and contracting terms.
• 1 to 2 years Medicaid experience preferred.
• Valid Driver’s License and current auto insurance. 
• Excellent communication skills.
• Support collaborative team efforts that produce effective working relationships and trust.
• Analyzes data and make sound, logical and timely decisions
• Leadership and negotiation skills.
• Promote staff development to full potential.
• Establishes priorities and sets long and short term goals.
• Fully knowledgeable of provider network and contracting issues

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.

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.

Discover more about us at www.amerihealthcaritas.com.