Top Provider Network Executive jobs in North Carolina

Your career starts now. We are looking for the next generation of health care leaders.

At AmeriHealth Caritas, we are 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 would like to connect with 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.

Responsibilities:

The AE II is responsible for building, nurturing and maintaining positive working relationships between AmeriHealth Caritas North Carolina (AHNC) and its contracted providers.  Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations.  AE II maintains in depth understanding of ACNC’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues.  Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the ACNC’s territory in keeping with State and Federal contact mandates for all products.  Identifies, contacts and actively solicits qualified providers to participate in ACNC at new and existing service areas and products, assuring financial integrity of the ACNC is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements.  Maintains complete understanding of ACNC reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating and implementing plans for providers to improve performance and measuring ongoing performance.  Supports the credentialing and re-credentialing processes, investigation of member complaints and any potential quality issues.  Maintains a functional working knowledge of Facets, including the provider database integrity. Identifies and maintains strong partnerships with appropriate internal stakeholders.  

An AE II’s accounts/assignments include:

• Large health systems.
• High spend providers with multiple practice locations and/or multiple specialties.

The AE II is responsible for developing/implementing/managing ongoing Provider Network Management projects, as needed.  

The AE II is responsible for participating or independently developing and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new AE’s. The AE II will assist AE I’s in resolving/managing issues with Providers.

Education/Experience: 

• Bachelor’s Degree or equivalent education and experience required.
• 3 to 5 years contract negotiation experience preferred.
• 3 to 5 years experience in a Provider Services position working with Health Systems.     
• 5 to 10 years experience in the managed care/health insurance industry with demonstrated strengths in: knowledge of Plan policies and procedures related to provider complaint resolution, provider credentialing, provider billing and payment, provider incentive programs and other key State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications;  working independently and managing complex projects and programs both as an independent owner and team leader, training and mentoring skills, interacting at an executive level internally and externally.  
• Substantive Senior Account Executive experience with high impact, high dollar, extremely visible and critical provider groups.
• Medicaid experience required and ACA Exchange experience preferred.
• This is a 100% remote position. Finalist can reside anywhere in North Carolina (Charlotte Metro preferred).

 Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

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.