Top Provider Network Executive jobs in Boca Raton, FL

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

At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities. As one of the nations leaders in health care 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 hear you.

Headquartered in Newtown Square, 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.

Discover more about us at www.amerihealthcaritas.com.

Responsibilities:

The AE I is responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers.AE I maintains an understanding of Plan’s contracts, provider performance and needs assisting in development of tailored provider orientation sessions, working to resolve provider issues.  Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the Plan’s territory in keeping w/ State and Federal contract mandates for all products. Identifies, contacts and actively solicits qualified providers to participate in Plan at new and existing service areas and products, assuring financial integrity of the Plan is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements.  Maintains complete understanding of Plan reports and metrics.  Uses data to develop and implement methods to improve relationships.  Assists in corrective actions required up to and including termination, following Plan policies and procedures. Corporate credentialing department with the credentialing and re-credentialing processes, investigation of member complaints, assists quality and grievance department with potential quality or service issues.  Maintains a functional working knowledge of Facets, including the provider database and routinely relays information about additions, deletions, or corrections to the Provider Maintenance Department. Maintains and delivers accurate, timely activity and metric reports as required.  Identifies and maintains strong partnerships with appropriate internal resources and stakeholders.

Education/Experience:

• Bachelor's degree or equivalent education and experience.
• High School Diploma/GED required.
• Problem-solving skills with an emphasis on conflict resolution preferred.
• 1 to 3 years' experience in a Provider Relations position working with Physicians, Hospitals and Ancillary provider types.
• 3 to 5 years' experience in the managed care/health insurance industry.
• Medicaid experience preferred.
• Medicare experience preferred.
• Credentialing experience preferred.
• Demonstrated strength in working independently, establishing influential relationships internally and externally, meeting and training facilitation skills, priority setting and problem-solving skills.
• Must be proficient in MS Office: Excel, Word, Teams & other applications (we will train you).
• Valid driver's license and automobile insurance required.
• Provider Relations services for this position will cover Miami Dade, Broward, and Palm Beach counties. 

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 including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.