Provider Network Account Executive II

Position Overview

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—with more than 30 years of experience—we deliver comprehensive, outcomes-driven care through integrated managed care products, pharmaceutical benefit management, specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at [please apply online].

The Provider Network Account Executive II (AE II) is responsible for developing strategic direction and managing day-to-day network activities for various provider types including single or multiple practices, integrated delivery systems, and other provider organizations. In this role, you will ensure appropriate access to services across the Plan’s territory while adhering to State and Federal mandates. If you want to make a difference and support the health of communities, we would like to connect with you.

Key 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 while upholding financial integrity and contract requirements.
• Utilize plan reports and metrics to evaluate and improve provider performance.
• Develop methods to enhance provider relationships and assist with corrective actions as needed.
• Assist with credentialing, re-credentialing, and investigation of member complaints and quality issues.
• Maintain proficiency with Facets and communicate provider database updates to the Provider Maintenance Department.
• Deliver accurate and timely activity and metric reports.
• Build strong partnerships with internal resources and stakeholders, including presenting to leadership and executive teams.
• Nurture provider partnerships and pursue value-based business opportunities to support local market strategy.
• Recruit providers to meet network adequacy targets.
• Resolve complex provider service complaints and negotiate effective solutions.
• Ensure accurate contract loading and submission, managing network implementation and ongoing maintenance.
• Manage ongoing projects or programs within the Provider Network Management organization.
• Develop and implement provider education programs and materials, and train new Account Executives.
• Support Value-Based Contracting (VBC) negotiations by leading VBC relationship initiatives and, when needed, spearheading negotiations.
• Consult on VBC contracts, facilitate successful outcomes with performance bonuses, and ensure compliance with VBC or State program requirements.
• Assist the AE I in effectively managing provider issues.

Required Qualifications

• Education: Bachelor's degree required.
• Experience Required: 5 to 10 years of substantive Account Executive experience with high-impact provider groups, including 3 to 5 years in VBC or Provider Services (network management and recruitment), and 5 to 10 years in managed care/health insurance.
• Proven experience in independent project management, training and mentoring, executive-level interaction, claims processing/billing knowledge, and network management.
• Requirements: Valid driver's license with appropriate automobile insurance and residency in the state of Ohio.
• Travel commitment of 10% to 25% is required for visits to provider offices within Ohio, including the Dublin, Ohio office.

Benefits & Perks

• Flexible work solutions including remote options and hybrid work schedules.
• Competitive pay along with paid time off, holidays, and volunteer events.
• Health insurance coverage for you and your dependents starting on your first day.
• 401(k) plan and tuition reimbursement opportunities.
• Be part of a mission-driven organization dedicated to building healthier communities.