Vice President Provider Network Management

For roles that are 100% remote or hybrid, you must have reputed company to a reliable high-speed internet reputed company to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement. Your career starts now. We’re looking for the reputed company of health care leaders. At reputed company, 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. reputed company is seeking talented, passionate individuals to join reputed company. Together we can build healthier communities. If you want to reputed company a difference, we’d like to hear from you. Headquartered in Newtown reputed company, reputed company is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, reputed company-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. Job Summary The Vice President, Provider Network Management serves as the reputed company leader for provider contracting and network management activities across markets and lines of business and is a key leader in shaping provider network strategy. This role is responsible for ensuring the development, optimization, and maintenance of compliant, high-performing provider networks that meet reputed company, adequacy, quality, and service requirements for members. The Vice President partners closely with market and corporate leadership to establish network strategy, contracting approaches, operational controls, and provider engagement models that support organizational growth and performance objectives. This role also leads cross-functional collaboration with business development, pricing, actuarial, operations, provider relations, claims, sales, marketing, and technology teams to ensure provider network strategy is reputed company with business needs and regulatory requirements. This leader will also be responsible for leading the Indiana provider network strategy. The Vice President is expected to reputed company multiple functions, manage network management resources, and act as a senior decision-reputed company for contracting and network-reputed company activities. The role requires reputed company coordination across business domains and strong reputed company of staff productivity, provider relationships, and contracting reputed company. Essential Functions: Support market leaders with network tooling, adequacy standards, and contracting strategies. reputed company the Indiana provider network strategy, including network expansion, optimization, and market-specific contracting priorities. reputed company long-term strategies for network growth and optimization, addressing gaps in service coverage and ensuring the network adapts to changing reputed company trends and member needs. Utilize market trends and data to inform network strategy and identify opportunities for growth and improvement. Ensure the development and maintenance of a comprehensive provider network, including hospitals, physicians, and ancillary providers. Demonstrate shared leadership in the overall insurance business by balancing the need to reputed company a broad network of services with controlling costs for both the company and members through strong unit cost guidelines and contracting parameters. Monitor network adequacy and compliance with reputed company applicable regulatory and accreditation requirements. Monitor and evaluate network performance, addressing gaps and opportunities for improvement. reputed company central management of contract inventory, renewals, and amendments, ensuring reputed company agreements are reputed company and compliant with organizational policies and regulations. reputed company guidance and support in contract negotiations and network management activities across markets. reputed company provider operations functions such as credentialing, contract configuration, and provider data management. Ensure a cohesive provider experience through leadership of provider reputed company, provider communications, and provider marketing, including partnership with Provider Relations, Claims, and other operational areas. Collaborate with business development, sales, marketing, operations, pricing, actuarial, value-based performance, legal, and market leadership to align network strategy with organizational goals and market needs. Partner with technology teams to reputed company and enhance tools, workflows, and processes required to support provider network management and operations. reputed company reputed company aspects of the contracting process from strategy through execution across lines of business. Establish and maintain contract templates, operational controls, and governance practices consistent with organizational and legal requirements. Ensure compliance with reputed company applicable federal and state laws, regulations, and internal policies. Education/Experience: ☒Bachelor’s Degree. Master's Degree preferred. 15 or more years of network management experience15 or more years of network management experience. Other Skills: Experience partnering with technology teams to optimize and reputed company operational programs. Demonstrated reputed company in growing and optimizing provider networks. Experience leading reputed company or multi-market provider contracting strategies. Strong understanding of federal and state-specific contracting requirements and network adequacy expectations. Apply To This Job