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AmeriHealth Caritas · 2 days ago

Senior Provider Network Account Executive

United States

Full-time

Remote

Senior Level

5+ years exp

AmeriHealth Caritas is a healthcare company focused on improving health outcomes and providing support to communities. The Senior Provider Network Account Executive is responsible for developing and maintaining relationships with providers to enhance performance in value-based contracting arrangements and managing a complex portfolio of providers.

Health CareInformation Technology

H1B Sponsor Likely

Responsibilities

Support overall network development and network management strategies

Assist departmental leadership with provider satisfaction, education, and communication initiatives

Contribute to Single Case Agreement (SCA) strategy

Participate in and implement provider network education programs and materials—both internal and provider‑facing—and serve as the trainer, mentor, and support resource for new Account Executives (AEs)

Lead and support hospital and physician network development and management, including participation in Joint Operating Committees (JOC) for designated provider groups and oversight of required quality review meetings with targeted providers and/or health systems

Build, nurture, and maintain strong relationships between the health plan and contracted providers, including highly complex provider entities

Resolve provider disputes in a timely and compliant manner

Manage a large and complex portfolio that includes multiple practice locations, multi‑specialty practices, hospitals, contracted subcontractors such as Durable Medical Equipment (DME) vendors, vision providers, and ancillary providers

Develop, implement, and manage programs and projects that impact high‑dollar and high‑membership provider groups

Conduct site visits as needed

Oversee and ensure resolution of provider issues managed by other Provider Network support teams

Take corrective action as required—up to and including termination—per organizational policies and procedures

Operationalize completed contracts of advanced complexity

Consult on Value‑Based Contracting (VBC) agreements, facilitate successful performance management (including JOCs, performance review meetings), and support incentive programs tied to performance improvement

Manage Value‑Based Contract (VBC) requirements, including monitoring provider performance standards in relation to VBC or State program expectations, coordinating with key stakeholders, and overseeing data‑sharing and reporting needs

Maintain general operational knowledge related to provider satisfaction, education, and communication, with a strong understanding of operational areas, including claims, payment integrity, provider data, credentialing, and appeals/disputes

Support contracting efforts for multiple product lines, including Long‑Term Services and Supports (LTSS), Health Insurance Marketplace/Exchange plans, and Dual Special Needs Plans (DSNP)

Assist with recruiting providers to address network adequacy gaps, particularly in high-complexity specialties or specific geographic areas

Support Value‑Based Contracting (VBC) negotiations and serve as the relationship lead; may also serve as lead negotiator

Qualification

Value-Based ContractingProvider Relationship ManagementNetwork DevelopmentFinancial AcumenCommunication SkillsProblem ResolutionMentoringProject Management

Required

Bachelor's degree required

5 or more years of experience demonstrating strong communication skills, financial acumen, and the ability to engage in difficult conversations

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)