Vice President Provider Network Management Medicaid Expert | Remote

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.

About this job:

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:

• Develop and execute a comprehensive provider engagement and contracting strategy to build effective, high-performing networks across all products and markets, aligned with corporate goals and regulatory requirements.
• Lead market contracting strategies that drive network performance, including cost-containment, provider satisfaction, and outcome-based arrangements such as value-based payment models and alternative payment contracts.
• Serve as a strategic thought partner to executive leadership, offering insights on network adequacy, access, and competitive positioning, including Medicaid and Medicare-related initiatives.
• Oversee contract negotiations and relationship management with key provider groups, health systems, and vendors; ensure terms are financially sound, compliant, and aligned with reimbursement methodology standards.
• Collaborate cross-functionally with leaders in clinical operations, medical economics, quality, compliance, legal, and finance to ensure network goals are integrated with enterprise-wide initiatives.
• Lead and develop the Corporate Provider Network Management team, building a culture of accountability, innovation, and performance while mentoring team members and ensuring departmental goals are met.
• Monitor provider performance trends using claims data, utilization patterns, and quality metrics to identify improvement opportunities and implement corrective actions as needed.
• Partner with internal stakeholders to support RFP responses, network expansions, product launches, regulatory filings, and state/federal audits related to provider network requirements.
• Manage relationships with delegated entities and vendors involved in provider network contracting, ensuring alignment with operational goals and adherence to AHC policies.
• Participate in internal and external stakeholder meetings, representing the organization in regulatory discussions, provider forums, and health plan partner engagements.

Education & Qualifications:

• Bachelor's degree in Business, Healthcare Administration, Healthcare Management, or a related field is required; Master's degree preferred.
• Minimum of 10 years of managed care experience, with emphasis on provider contracting and reimbursement. Must have in-depth knowledge of reimbursement methodologies, value-based payment models, and negotiation of complex contract terms.
• 8 to 10 years of progressive business management and contract negotiation experience, preferably within a health plan or payer environment.
• At least 5 years of management experience, with demonstrated success leading teams, driving results, and overseeing large-scale projects.
• 1 to 2 years of Medicaid experience preferred, with familiarity with regulatory requirements and Medicaid-specific contract strategies.

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 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.