Provider Network Account Executive II - REMOTE
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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 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 .
Responsibilities:
Under the supervision of the New Hampshire Manager of Value-Based Contracting, the Value-Based (VBC) Contracting Account Executive (AE) II acts as the subject matter expert for value-based providers and is responsible for building, nurturing and maintaining positive working relationships with providers in VB programs. The incumbent will work closely with the Provider Network Management (PNM) team and other key stakeholders to increase provider participation in VB programs, as well as provider training and engagement in programs. The VBC AE II will serve as subject matter expert for assisting providers with access to data and best practices. The incumbent will also have a complete understanding of available reports and metrics in order to evaluate the performance of assigned providers/practices/facilities, determining, communicating and implementing plans for providers to improve performance and measuring ongoing performance. Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.
Key Responsibilities include:
- Develops and conducts relevant and tailored provider education sessions and Joint Operations Committee meetings, making educational visits as needed, and working to resolve provider issues.
- Assists in the monitoring and management of the value-based provider network, ensuring compliance with State and Federal regulations and requirements and ensuring that the financial integrity of value-based programs is maintained.
- Ensures that contract management requirements are adhered to, including language, terms and reimbursement requirements.
- Develops and delivers internal reports to facilitate Plan data-driven decision-making.
- Develops and transmits ad-hoc and regular reports to value-based providers to ensure their success under the Plan's value-based programs.
- Develops, maintains and updates value-based program Provider Manuals.
- Develops and maintains strong partnerships with appropriate internal resources and stakeholders.
- Assists in the drafting of value-based contracts and contract amendments.
- Assists in the development and implementation of value-based programs.
Education/Experience:
- Bachelor's Degree.
- A minimum of 1 year Managed Care Provider Contracting and Reimbursement experience, at an independent high-dollar contracting level, focusing on value based and innovative payment methodologies. Proven influencing skills with internal and external stakeholders. 1-2 years Medicaid experience preferred.
- 2 - 3 years experience in a Provider Relationship Management position working with providers