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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 Philadelphia, 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.
Reporting to the Director, Corporate Network Development, the Director New Business Network Development drives the strategy and execution of provider network development efforts for new Medicaid & Medicare markets in the assigned geographic region. This position leads a team in the recruitment of providers and building networks. This position will also be responsible for understanding the contractual and regulatory requirements required to ensure network adequacy.
- Responsible for the strategic planning and execution of all new provider network development in the assigned territory.
- Identifies recruits, negotiates and implements contracts with the most critical and complex providers and provider systems.
- Establishes effective relationships with critical Provider Associations in new markets.
- Identifies state and CMS provider requirements in advance of/during new business activation to ensure compliance.
- Develops key relationships, identifies unique contracting strategies (including accountable care organization contracting methodologies) and coordinates implementation of these strategies.
- Collaborates with the Plan leadership and PNM teams to ensure successful transition of market once operational.
- Bachelor’s Degree n Business or health related disciplines such as Healthcare Administration or Healthcare management or equivalent business experience.
- 8-10 years of previous network development, provider relations, or related experience required. Medicaid Managed Care and Medicare experience strongly preferred.
- Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work and managing the performance of staff.
- Experience working across an enterprise and working in complex organizations.
- Strong understanding of customer and market dynamics and requirements.
- Ability to travel extensively to various locations for development of provider networks.
- Willingness to work in a national team of professionals.
- Strong negotiation and listening skills.
- Proven leadership and ability to drive results.
- In depth knowledge of Provider network Management processes and programs, e.g., PIP, Hospital Savings Programs, Accountable Care organizations and Patient Centered Medical Home strongly preferred.