Job Summary

The primary responsibility of AE Sr. is to develop strong relationships with providers to drive for performance specifically as it relates to core providers who are on risk-based or cost sharing VBC arrangements as well as large health system contracts.

Work Arrangement: 

Must reside in North Carolina.  Bachelor's degree required. 

Essential Functions:

• Supports network development and network management strategies. 
• Responsible for assisting the Leader with departmental activities related to provider satisfaction, education, and communication. 
• Assist in SCA strategy. 
• Responsible for participating and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new AE’s. 
• Responsible for hospital and physician network development and management; including joint operating committees (JOC) for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems. 
• Responsible for building, nurturing and maintaining positive working relationships between Plan and its contracted providers; including those that are most complex.
• Resolve Provider disputes in a timely and compliant manner.
• Responsibility for a higher number of multiple practice locations and multi-specialty practices and multiple providers. Should also include hospital systems, contracted subcontractors (DME, Vision, etc.), and ancillary providers.
• Develop/implement/manage programs and projects that support/impact high dollar and high member provider groups.
• Perform site visits as needed.
• Oversee resolution of provider issues managed by other Provider Network support teams. 
• Take corrective actions required up to and including termination, following Plan policies and procedures.
• Operationalizes completed contracts with advanced complexity.
• Consults on VBC contracts, facilitates for success (JOCs, performance overview, etc.) with specific bonuses attached to performance improvement.
• Responsible to maintain and manage Value-Based contract requirements, including but not limited to; monitoring performance standards against VBC or State program requirements, working with key stakeholders and provide oversight on applicable data-sharing or report requirements.
• Responsible for hospital and physician network development and management; including joint operating committees (JOC) for identified groups, oversight of necessary quality review meetings with targeted providers and/or health systems
• 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. 
• Support contracting for multiple product lines, including LTSS, Exchange, DSNP adequacy gaps (high complexity).
• Assist with recruiting providers based on identified network adequacy gaps (high complexity).
• Support of VBC negotiations; lead in VBC relationships; may lead negotiations.

Education/Experience:

• Bachelor’s Degree required
• Ability to interpret data and develop action plans as a result of the data.  
• 5 or more years strong communications skills, financial acumen, ability to have difficult conversations.

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.

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 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’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.