Provider Network Account Executive II

Your career starts now. We are looking for the next generation of healthcare leaders.

At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare 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 would like to connect with you.

Headquartered in Newtown Square, PA, 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.

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Position Overview: The Provider Network Account Executive II (AE II) is responsible for developing strategic direction and managing day-to-day network activities for all provider types, including single or multiple practices, integrated delivery systems, and other provider organizations. This role involves understanding the Plan’s contracts and provider performance, conducting tailored orientation sessions, educational visits, and resolving provider issues. The AE II ensures appropriate access to services across the Plan’s territory, adhering to State and Federal mandates for all products.

Responsibilities:

Monitor and manage the provider network to ensure service accessibility and compliance with mandates.

Identify, contact, and solicit qualified providers to join the Plan, maintaining financial integrity and contract requirements.

Use plan reports and metrics to evaluate and improve provider performance.

Develop methods to enhance provider relationships and assist in corrective actions as needed.

Assist with credentialing, re-credentialing, and investigating member complaints and quality issues.

Maintain knowledge of Facets and relay provider database updates to the Provider Maintenance Department.

Deliver accurate, timely activity and metric reports.

Build strong partnerships with internal resources and stakeholders.

Highly effective communicator, comfortable with public speaking and presenting to leadership and executive teams.

Nurture provider partnerships and seek value-based business opportunities to support local market strategy.

Recruit providers to meet network adequacy targets.

Resolve complex provider service complaints and negotiate solutions.

Ensure accurate contract loading and submissions and manage network implementation and maintenance.

Manage ongoing projects or programs within the Provider Network Management organization.

Develop and implement provider education programs and materials, and train new AEs.

Support of Value-Based Contracting (VBC) negotiations; lead in VBC relationships; may lead negotiations

Consults on VBC contracts, facilitates for success (JOCs, performance overview, etc.) with specific bonuses attached to performance improvement

Responsible to maintain and manage VBC requirements, including but not limited to; monitoring performance standards against VBC or State program requirements, working with key stakeholders and provide oversight on applicable data-sharing or report requirements

Assist AE I in managing provider issues.

Education & Experience:

Bachelor's degree required.

5 to 10 years of substantive Account Executive experience with high-impact provider groups

3 to 5 years in VBC, Provider Services, including network management and recruitment required

5 to 10 years in managed care/health insurance.

Independent project management, training and mentoring, executive-level interaction, claims processing/billing knowledge, payment methodologies, and network management.

Travel: Requires 10% to 25% travel to provider office within Ohio as well as to our Dublin, Ohio office.

Driver’s License: Valid driver’s license and automobile insurance required.

Qualified candidates must reside in the state of Ohio.

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve. We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

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 one, 401(k) tuition reimbursement, and more.