AmeriHealth Caritas Director Provider Network Management in Des Moines, Iowa

Director Provider Network Management


Description

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 www.amerihealthcaritas.com.

Responsibilities:

The primary purpose of the job is to be responsible for all hospital, physician and physician extender network development and management. 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.

  • Achieves company targets through aggressive primary care, specialty and ancillary provider contracting as well as risk contract management
  • Conducts the most complex negotiation and handles contracts involve non-standard arrangements that require a high level of negotiation skills.
  • Leads a team of department managers in developing and executing strategic departmental initiatives.
  • Manages required Hospital Contracting as appropriate.
  • May work on projects impacting the business unit requiring collaboration with other key areas or serve on enterprise projects around network management
  • Monitors primary care and specialty risk arrangements.
  • Performs data analysis and develops specific actions to manage medical cost trend.
  • Prepares financial projections and conducts analysis.
  • Serves as a communication link between professional providers and the company.
  • Serves as a subject matter expert for local contracting efforts or in highly specialized components of the contracting process and serves as subject matter expert for that area for a business unit.
  • Serves in a leadership capacity, leading associate resources, special projects/initiatives, or network planning.
  • Spends a minimum of 50% of the time either in a leadership role or that of subject matter expert and deals with only the most complex providers, such as institutional providers, large medical groups and ancillary providers, and providers in areas with significant competition.
  • Typically serves as lead contractor for large scale, multi-faceted negotiations.

Education/Experience:

  • Bachelor’s Degree in Business or health related disciplines such as Healthcare Administration or Healthcare Management or equivalent business experience.
  • Masters in Business Administration or Masters in Healthcare Administration is preferred.
  • A minimum of 3 years Managed Care Provider Contracting and Reimbursement experience to include in depth knowledge of reimbursement methodologies and contracting terms; 1-2 years Medicaid experience preferred.
  • A minimum 8-10 years of progressive business management and negotiation experience. Minimum 5 years management experience, managing teams and project management.
  • Works independently and requires high level of judgment and discretion.