AmeriHealth Caritas · 3 months ago
Manager Provider Network Management
North Charleston, SC
Full-time
Hybrid
Mid, Senior Level
5+ years expAmeriHealth Caritas is a mission-driven organization that specializes in healthcare solutions. The Manager of Provider Network Management is responsible for overseeing the Network Management department's activities, ensuring provider satisfaction, education, and compliance with regulations, while also managing recruiting and contracting activities.
Health CareInformation Technology
Responsibilities
Assist leader with driving network management strategy
Responsible for assisting the leader with departmental activities related to provider satisfaction, education and communication
Responsible for assisting in the development and execution of annual provider network strategy to include network adequacy standards, as well as a marketable network
Implement and oversee market strategies
Responsible for staffing decisions and managing the day-to-day activities of the Account Executives, Quality Practice Advisors and Provider Network Coordinators
Assist department leader to ensure department staff remains compliant in all aspects of Federal and State rules, regulations, policies and procedures and creates or modifies departmental policies to reflect changes
Oversight and resolution of provider disputes
Oversees training and communication for network providers and acts as a liaison with the provider community
Establishes a priority list of new geographical locations and types of providers to be added to the Plan network in alignment with Plan departments
Works with Plan departments to retain network providers at risk for termination. Develops and executes plan for large scale provider terminations
Participates in Plan and physician committees as appropriate
As applicable, strategic planning of facility and physician network value based contracting development and management
As applicable, assists territory Account Executives with planning, implementing and monitoring value-based programs
Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan's territory
Develop / assist in development of provider trainings and communications
General operational knowledge related to provider satisfaction, education and communication
Support Value Based contract negotiations; lead negotiator where needed
Other duties assigned
Qualification
Required
A bachelor's degree required in business or a health-related discipline, such as healthcare administration
healthcare management or equivalent education and business experience is required
2 to 3 years of Medicaid experience is required
1 to 3 years managing health insurance, Medicaid Business
5 years of provider contracting/reimbursement experience in a healthcare setting
3 years of supervisory/management/leadership experience, preferably in a managed care organization setting
Must be able to communicate effectively with the leadership and team members
The candidate must be in South Carolina and have a valid driver's license and car insurance
Benefits
Flexible work solutions include remote options, hybrid work schedules
Competitive pay
Paid time off
Holidays and volunteer events
Health insurance coverage for you and your dependents on Day 1
401(k) tuition reimbursement
And more.
Company
AmeriHealth Caritas
AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.
10001+ employees
H1B Sponsorship
AmeriHealth Caritas has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (18)
2024 (17)
2023 (12)
2022 (14)
2021 (4)
2020 (11)
Funding
Current Stage
Late StageLeadership Team
Kathleen Giblin
SVP Clinical Operations
Ash Hanson
Executive Vice President & Chief Human Resources Officer
Recent News
2025-11-06
The Philadelphia Inquirer
2025-10-02
2025-10-01
Company data provided by crunchbase