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AmeriHealth Caritas · 1 day ago

Provider Network Management Contractor

Southfield, MI

Full-time, Contract

Hybrid

Mid Level

3+ years exp

AmeriHealth Caritas is seeking a Provider Network Management Contractor responsible for developing, contracting, and maintaining provider relationships within an assigned market. This role ensures the network is competitive, compliant, and aligned with organizational strategy, while also supporting overall network development strategy and negotiating provider contracts.

Health CareInformation Technology

H1B Sponsor Likely

Responsibilities

Supports overall network development strategy

Assists departmental leadership with provider satisfaction, education, and communication efforts

Negotiates provider contracts to achieve network strategy and maintain an adequate, compliant, and marketable network

Negotiates Single Case Agreement (SCA) rates and converts SCA providers to contracted status

Recruits and contracts providers to address network adequacy gaps, including high‑complexity specialties

Ensures all contracts comply with Federal and State regulations, policies, and departmental procedures

Structures contracts that support quality initiatives such as: Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), National Committee for Quality Assurance (NCQA), and Utilization Review Accreditation Commission (URAC)

Negotiates contract terms that drive provider satisfaction

Works with CPNM (Clinical Provider Network Management) to manage the annual contracting schedule and expand the network as needed

Serves as a payment/fee schedule Subject Matter Expert (SME) for complex specialties such as Federally Qualified Health Centers (FQHCs), Behavioral Health (BH), anesthesia, and others; available to support Account Executives (AEs) with claims resolution

Maintains operational knowledge of key functions affecting the provider experience, including claims, payment integrity, provider data, credentialing, appeals, disputes, and related processes

Negotiates provider agreements consistent with claims payment methodologies

Expands or modifies the provider network to support new products or client needs

Reviews contract terms and collaborates with Legal to secure optimal language

Supports contracting activities across multiple product lines, including Long-Term Services and Supports (LTSS), Exchange (ACA Marketplace plans), and Dual Special Needs Plans (DSNP)

Acts as the lead negotiator for VBC (Value-Based Contracting) in partnership with the AE

Qualification

Contract negotiationProvider relationship managementFinancial acumenReimbursement methodologiesBachelor's degreeAccount Executive experienceValue-Based ContractingCommunication skills

Required

Bachelor's degree required

3 or more years of Account Executive experience

Minimum of 1 year of contract negotiation experience

Demonstrated financial acumen and ability to navigate difficult conversations

Understanding of reimbursement methodologies, including risk‑based and value-based contracting

Company

AmeriHealth Caritas

Glassdoor3.4

AmeriHealth Caritas is the health care solutions provider for those in most need and the chronically ill.

Founded in 1982

Philadelphia, Pennsylvania, USA

10001+ employees

http://www.amerihealthcaritas.com

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)