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Assistant Manager - Westfield Fashion Square, Hollister
A&F Stores, Inc.
Sherman Oaks, CA
- $24 USD / hour
The Assistant Manager is a multi-faceted role that merges business strategy, operations, creativity, and people management. Strategically, assistant managers are responsible for driving…
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Project Manager - Top Secret Clearance
Red Hat
Austin, TX
Interact with all project resources and Senior Red Hat and Customer management, and Red Hat Support teams, for example, Resource Management, Operations and Finance
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MA
Fueling Operations Manager - ITP
Menzies Aviation
Austin, TX
- $85,000 USD / year
We have an amazing opportunity to join our fantastic Menzies Aviation team as an Airport Fueling Operations Manager to support the operations in Austin-Bergstrom International Airport.
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Software Developer, GO Systems
Meta
Austin, TX
GO Systems, within Product and Regulatory Operations (PRO), is a technically-minded team responsible for developing and executing a unified, interoperable infrastructure strategy across…
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Senior .NET Full Stack Developer – C#
Cognizant
Austin, TX
- $86,000 to $99,000 USD / year
…scalable enterprise applications that support healthcare payer operations, including eligibility, benefits, claims adjudication, billing, and provider…
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Senior Full Stack Engineer – .NET & C#
Cognizant
Austin, TX
- $86,000 to $99,000 USD / year
…scalable enterprise applications that support healthcare payer operations, including eligibility, benefits, claims adjudication, billing, and provider…
Added just now
C
Senior .NET Full Stack Engineer with C#
Cognizant
Austin, TX
- $86,000 to $99,000 USD / year
…scalable enterprise applications that support healthcare payer operations, including eligibility, benefits, claims adjudication, billing, and provider…
Added just now
AS
Assistant Manager - Northridge Fashion Center, Hollister
A&F Stores, Inc.
Northridge, CA
- $24 USD / hour
The Assistant Manager is a multi-faceted role that merges business strategy, operations, creativity, and people management. Strategically, assistant managers are responsible for driving…
Added just now
Site Quality Manager
Collins Aerospace
Richardson, TX
…problems. With our three market leading businesses, world-class operations and investments in research and development, we offer capabilities and opportunity no one else can. Together, we…
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Program Analyst
Veterans Affairs, Veterans Health Administration
San Antonio, TX
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Operations Lead - Mall at Short Hills
ALO
Millburn, NJ
- $19 to $23 USD / hour
Directly oversee the Operations Associates; responsible for recruitment and development of talent
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Supply Chain Demand Planner
Kiss Nail Products, Inc.
NY
· Run a structured demand review cadence with Sales, Marketing, Product Development, and Finance, with documented forecast assumptions and follow-up on exceptions.
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Youth Development Professional
Boys & Girls Clubs of the Coastal Plain
Cape Carteret, NC
The Youth Development Professional (YDP) is a front-line program staff member at a Blue Door Academy school-based site. Working up to 22.5 hours per week, the YDP reviews, facilitates, and…
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Machinist (1st Shift)
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Orange City, IA
SEKISUI Aerospace is a federal contractor and is required to participate in the federal government’s E-Verify program. E-Verify allows us to confirm the employment authorization of newly…
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Participate in the company’s Zero Defects program – involvement in developing solutions to process issues that create scrap/MRB/rework.
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Review vendor and general contractor Quality and Commissioning program plans to ensure conformance with owner standards and project specifications.
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Night Auditor
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Provide information and explain I Prefer program.
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Night Auditor - Part Time
The National Hotel
Miami Beach, FL
- Part-time
Provide information and explain I Prefer program.
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DTC Regional Sales Manager
American Standard
Remote - Atlanta, GA
hiring, training, and managing independent sales representatives. You will oversee sales operations
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Manager, IS Project Management Office
HealthPoint Brand
Renton, WA
Lead and manage a team of Technical Project Managers and/or Senior Technical Project Managers, including hiring, performance management, coaching, and professional development.
Added 1 min ago
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Data and Compliance Manager
Community SeniorServ Inc
Anaheim, CA · Santa Ana, CA
- $75,000 to $90,000 USD / year
Five or more years of experience in data management, compliance, reporting, analytics, quality improvement, program operations, or related work.
Added 1 min ago
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Machine Operator
Aerotek
Hamilton, NJ
- $21 to $25 USD / hour
…inspections of printed products. This role involves finishing operations to complete rolls of labels and package them, recording results on designated forms, and operating machinery…
Added 1 min ago
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Assembler
Aerotek
Mankato, MN
- $20 USD / hour
…drawings, and written instructions while supporting production operations. This role ensures that all products meet quality standards for fit, form, and function and contributes to a safe,…
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EMT Emergency Medical Tech EMS Lakeland Days
Team Member Services
United States
Must complete a 16-hr emergency vehicle operations training program.
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ICU Assistant Nurse Manager
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Amerihealth Caritas

Vice President Provider Network Management

Philadelphia, PA, United States

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Job details

Posting language: English
Posted: Nov 9, 2026

Original job description

Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re 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’d like to hear from 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. Job Summary This position will provide comprehensive senior leadership and strategic direction to the market network management teams in developing and maintaining effective, high-performing market networks. Responsible for managing leaders that manage and contract all hospital, physician, ancillary, facility, and physician extender network development and management for all products in the market. This position is also responsible for coordination and collaboration to align with enterprise objectives to improve provider partnerships and satisfaction. This position will interact with high-volume hospital and physician practice chief executive officers, chief financial officers, directors of managed care, other high-level executives, and AmeriHealth Caritas’s executive leadership.

Responsibilities:

Responsible for creating (and executing) a provider engagement and contracting strategy to develop efficient and high-performing market networks that support all products.
Strategic development is completed in cooperation and agreement with the enterprise Provider Network vision, policies, and technologies.
Lead the market in contracting negotiations with significant, critical healthcare systems.
Responsible for overseeing all provider engagement strategies that enhance provider satisfaction and performance; engagement strategies may include but are not limited to addressing key health plan quality and operational goals, provider partnerships, and joint operating committees.
Responsible for representing the market in measuring provider satisfaction and leading engagement across the market to develop necessary strategies to improve provider satisfaction scores in focused areas.
Invest in developing market network team training programs to ensure high performance.
Be a thought leader with the Corporate Provider Network Management team in developing new, operationally administrable, market-leading provider partnership programs, including the continuum of Value-Based Care programs and electronic connectivity strategies.
Manage all required network operation performance areas to ensure the network is configured and performing in compliance with the terms of the provider contract, the state contract, and reimbursement methodologies.
Ensures market provider contracting policies and practices adhere to all federal and regulatory requirements.
Responsible for developing and executing the comprehensive provider network strategy in partnership with the Corporate Provider Network Management team.
Oversees the negotiation and management of market provider contracts.
Ensures compliance with pricing guidelines established by AmeriHealth Caritas (AHC) and Plan.
Complies with established contract implementation process(s) for all contracts and oversees coordination with enterprise-shared services to address provider payment issues as they arise.
Ensures department staff remains current in all aspects of federal and state rules, regulations, policies, and procedures; creates or modifies departmental policies to reflect changes;
Responsible for implementing electronic strategies for the provider network, including increasing electronic claims submission and implementing improved processes that result in increased auto-adjudication of claims and reduced claims rework.
Ensures provider contracting is consistent with claim payment methodologies.
Maintains familiarity with State Medicaid fee schedules and analyzes comparable Plan pricing guidelines.
Ensures provider contracting policies are adhered to as they relate to standard contract language.
Ensures that non-standard contract elements are communicated to appropriate departments and obtains AHC and Plan approval before submission to the provider.
Responsible for compliance with network adequacy standards as required by the state agreements.
Augments and modifies the existing provider network to accommodate new products or clients as necessary.
Ensures the provider network meets the healthcare needs of Plan members.
Ensures provider communication and education meets AHC and Plan needs and liaises with the designated provider community.
Resolves individual provider complaints promptly to ensure minimal disruption of the Plan’s network.
Ensures capitation, provider rosters, and RHC/FQHC reports are monitored, strategies are developed, and plans are implemented to address outliers.
Ensures the achievement of financial, quality, and clinical objectives by accomplishing provider initiatives.
Responsible for departmental staffing decisions and supervises assigned staff, writes and performs annual reviews, and monitors performance issues as they arise.
Leads team in a manner conducive to ongoing growth and expanded knowledge of associates.
Coach team members using data and appropriate analytical tools that support improved quality.
Support team members in identifying and creatively resolving problems for improved processes and expanded use of technology.
Support collaborative team efforts that produce effective working relationships and trust.
Systematically informs staff of policy and procedural changes affecting program and administrative operations.
Regularly suggests innovative means of structuring operations that help alleviate backlogs and ensure the optimal utilization of resources.
Coordinates department’s efforts with those of other departments.
Review reports on annual provider satisfaction surveys; develop plans to improve identified areas of concern; work with other departments to develop quality assurance initiatives based on survey results.
Develops and ensures compliance with the department budget.
Participates in Plan and physician committees as appropriate.
Performs other related duties and projects as assigned.
Adheres to AHC policies and procedures.

Education & Qualifications:

A bachelor’s degree in Business or health-related disciplines such as Healthcare Administration or Healthcare Management or equivalent business experience.
Master’s Degree preferred.
A minimum of 5 years Managed Care Provider Contracting and Reimbursement experience in Pennsylvania, to include in depth knowledge of reimbursement methodologies and contracting terms.
1 to 2 years Medicaid experience preferred.
Minimum 8 to 10 years of progressivebusiness management and negotiation experience.
Minimum 5 years management experience, managing teams and project management.

Other:

Driver's License in state of residency.
Access to auto with at least state minimum auto insurance.

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 1, 401(k) tuition reimbursement, and more.

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