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Added 36 mins ago
Network Contractor Provider Network Management
AmeriHealth Caritas Health Plan
Newark, DE
Added 36 mins ago
Practice Performance Advisor
AmeriHealth Caritas Health Plan
Newark, DE
Added 36 mins ago
Coordinator Provider Network
AmeriHealth Caritas Health Plan
Newark, DE
Added 36 mins ago
Senior Account Executive
AmeriHealth Caritas Health Plan
Newark, DE
Added 36 mins ago
Account Executive
AmeriHealth Caritas Health Plan
Newark, DE
Added 3 days ago
Director, Quality Management
AmeriHealth Caritas Health Plan
Philadelphia, PA
Added 3 days ago
Senior Clinical Training Specialist
AmeriHealth Caritas Health Plan
Remote, United States
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AmeriHealth Caritas Health Plan
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Market Director, Social Care & Health Impact
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Added 24 days ago
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AmeriHealth Caritas Health Plan
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AmeriHealth Caritas Health Plan
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AmeriHealth Caritas Health Plan
Southfield, MI
Added 24 days ago
Care Connector
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Network Contractor - Provider Network Management (PNM)
AmeriHealth Caritas Health Plan
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AmeriHealth Caritas Health Plan

Network Contractor Provider Network Management

Newark, DE, United States

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Job details

Posting language: English
Posted: Nov 9, 2026

Original job description

Role Overview: The primary responsibility of the Network Contractor is contracting providers, the contracting and re-contracting of providers in an established market.

Work Arrangement:

Remote – This position is fully remote. The Associate must be located in Delaware (DE) to attend in office meeting as needed.

Responsibilities:

Supports network development strategy.
Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication.
Responsible for negotiating contracts to execute on network strategy and ensure an adequate, compliant and marketable network.
Responsible for negotiating Single Case Agreements (SCA) rates and converting SCA providers to contracted.
Responsible for recruiting and contracting providers based on identified network adequacy gaps (high complexity).
Ensure all contracts are negotiated to be compliant with Federal and State rules, regulations, policies and procedures and follow all departmental policies.
Ensures contracts are supportive of Plan quality initiatives such as HEDIS, CAHPS and NCQA/URAC.
Negotiates contracts to support management of provider satisfaction.
Contractors will work with Corporate Provider Network Management to manage the annual contracting schedule as well as supplement the network as new providers are available or needed.
Payment/fee schedule SMEs to develop resources in complex specialties i.e. FQHCs, BH, anesthesia etc.
These SMEs will be available to AEs when needed for support of claims resolution.
General Operational Knowledge related to provider satisfaction, education and communication with a fundamental understanding of operational items such as claims, payment integrity, provider data, credentialing, appeals disputes etc.
Negotiates provider contracts consistent with claim payment methodologies.
Augments and modifies the existing provider network to accommodate new products or clients as necessary.
Reviews contract language and collaborate with legal to ensure best contract terms.
Support contracting for multiple product lines, including Exchange, DSNP.
Lead negotiator of Value Based Contracting in conjunction with AE.

Education & Experience:

Bachelor's degree.
5 or more years of experience if no bachelor’s degree is preferred
3 or more years of Account Executive experience
Financial Acumen.
Ability to have difficult conversations.
1 or more years contract negotiation experience.
Understanding of reimbursement methodologies to include risk or Value Based contracting.
Proficiency using MS Office Suite.

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