Manager Provider Network Management - AmeriHealth Caritas Family of Companies : Job Details

Lead strategic planning, development, and management of the hospital and physician provider network to meet member needs and ensure network adequacy. Oversee provider contracting processes, ensuring compliance with pricing guidelines, contract standards, and claim payment methodologies. Drive implementation of electronic strategies to improve claims submission, auto-adjudication, and operational efficiency. Ensure departmental compliance with Federal and State regulations, develop policies accordingly, and lead provider communication, education, and satisfaction initiatives. Supervise, coach, and develop team members to achieve financial, quality, and clinical objectives while fostering innovation, collaboration, and continuous improvement. Ability to negotiate and develop partnerships with new and existing providers within New Hampshire. Education/ Experience:A bachelors degree in business or health-related disciplines, such as healthcare administration or healthcare management, and ...Manager, Network, Management, Healthcare, Project Management, Behavioral Health