Job Description

Your career starts now. We\xe2\x80\x99re looking for the next generation of health care leaders.

At AmeriHealth Caritas, we\xe2\x80\x99re 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\xe2\x80\x99d 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 .

Responsibilities:

Under the supervision of the New Hampshire Manager of Value-Based Contracting, the AE II acts as the main point of contact for value-based providers, building and maintaining positive working relationships between the Plan and providers.

• Develops and conducts relevant and tailored provider education sessions and Joint Operations Committee meetings, making educational visits as needed, and working to resolve provider issues.
• Assists in the monitoring and management of the value-based provider network, ensuring compliance with State and Federal regulations and requirements and ensuring that the financial integrity of value-based programs is maintained.
• Ensures that contract management requirements are adhered to, including language, terms and reimbursement requirements.
• Develops and delivers internal reports to facilitate Plan data-driven decision-making.
• Develops and transmits ad-hoc and regular reports to value-based providers to ensure their success under the Plan\xe2\x80\x99s value-based programs.
• Develops, maintains and updates value-based program Provider Manuals.
• Develops and maintains strong partnerships with appropriate internal resources and stakeholders.
• Assists in the drafting of value-based contracts and contract amendments.
• Assists in the development and implementation of value-based programs.

• Bachelor\xe2\x80\x99s Degree.
• 1-3 years Provider Services experience with high impact, high dollar, extremely visible and critical provider groups.
• 5-10 years experience in the managed care/health insurance industry with demonstrated strengths in: provider credentialing, provider billing and payment, provider incentive programs and other key State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications; working independently and managing complex projects and programs both as an independent owner and team leader, training and mentoring skills, interacting at an executive level internally and externally.

Amerihealth