Job Overview
Employment Type
Full-time
Work Schedule
Flexible
Benefits
Flexible work solutions
Remote options
Hybrid Schedules
competitive pay
Paid Time Off
Health Insurance
401(k)
Tuition Reimbursement
Job Description
AmeriHealth Caritas is a mission-driven healthcare organization headquartered in Newtown Square, PA, with a rich legacy spanning over 30 years. As one of the nation’s leading providers of integrated managed care solutions, AmeriHealth Caritas focuses on delivering comprehensive, outcomes-oriented care to underserved populations. The company specializes in various healthcare services, including managed care products, pharmaceutical benefit management, specialty pharmacy services, and behavioral health programs. AmeriHealth Caritas operates on a national scale, impacting millions of lives through its innovative and award-winning programs designed to improve health outcomes and foster community wellness.
At AmeriHealth Caritas, the commitment to enhancing healthcare access and quality is reflected through a dedicated team of professionals who work collaboratively to help people get care, stay well, and build healthier communities. The organization prides itself on supporting its associates by offering extensive benefits, flexible work arrangements including remote options, competitive pay, and opportunities for professional growth. Being part of AmeriHealth Caritas means contributing to a larger mission that prioritizes the needs of vulnerable populations and continuously strives to improve the healthcare landscape with compassionate and effective care management.
The role of Community Health Choices (CHC) Provider Network Account Executive is integral to AmeriHealth Caritas’s mission. This position serves as the primary liaison between the health plan and a diverse portfolio of healthcare providers, including solo practitioners, multi-site groups, and integrated delivery systems. The account executive ensures these providers receive the support and resources necessary to deliver exceptional care to AmeriHealth Caritas members. This entails fostering strong, trust-based partnerships and ensuring clear communication and understanding of contract terms, provider needs, and performance expectations.
In this role, you will be responsible for onboarding new providers through tailored education sessions, addressing concerns promptly, and supporting provider engagement and satisfaction. You will monitor network adequacy to ensure compliance with state and federal access standards across multiple product lines, recruit qualified providers for both new and existing service areas while aligning with financial and contractual guidelines, and analyze provider performance data to collaboratively develop improvement strategies. The role also involves supporting corrective action processes in accordance with plan policy and working closely with the Quality Management team on credentialing, member complaints, and quality-of-care investigations. Maintaining accurate provider data and submitting timely reports on activities and outcomes is crucial, as is building effective partnerships across internal departments and stakeholders.
The position supports remote work flexibility but requires candidates to reside within Central or Eastern Time Zones, preferably near Pennsylvania, to maintain alignment with the organizational schedule and attend annual conferences as needed. The ideal candidate is a self-starter with excellent time management, problem-solving skills, and the ability to manage competing demands effectively. Strong collaboration skills are essential for working within cross-functional teams to advance network goals and improve care delivery.
This full-time role provides a rewarding career opportunity to contribute to a nationally recognized organization committed to health equity, quality care, and innovation in managed healthcare. AmeriHealth Caritas’s comprehensive benefits package supports your personal and professional well-being with health insurance from day one, paid time off including holidays and volunteer events, 401(k) plans, tuition reimbursement, and flexible scheduling options. Join AmeriHealth Caritas and make a meaningful impact on healthcare delivery in communities that need it most.
At AmeriHealth Caritas, the commitment to enhancing healthcare access and quality is reflected through a dedicated team of professionals who work collaboratively to help people get care, stay well, and build healthier communities. The organization prides itself on supporting its associates by offering extensive benefits, flexible work arrangements including remote options, competitive pay, and opportunities for professional growth. Being part of AmeriHealth Caritas means contributing to a larger mission that prioritizes the needs of vulnerable populations and continuously strives to improve the healthcare landscape with compassionate and effective care management.
The role of Community Health Choices (CHC) Provider Network Account Executive is integral to AmeriHealth Caritas’s mission. This position serves as the primary liaison between the health plan and a diverse portfolio of healthcare providers, including solo practitioners, multi-site groups, and integrated delivery systems. The account executive ensures these providers receive the support and resources necessary to deliver exceptional care to AmeriHealth Caritas members. This entails fostering strong, trust-based partnerships and ensuring clear communication and understanding of contract terms, provider needs, and performance expectations.
In this role, you will be responsible for onboarding new providers through tailored education sessions, addressing concerns promptly, and supporting provider engagement and satisfaction. You will monitor network adequacy to ensure compliance with state and federal access standards across multiple product lines, recruit qualified providers for both new and existing service areas while aligning with financial and contractual guidelines, and analyze provider performance data to collaboratively develop improvement strategies. The role also involves supporting corrective action processes in accordance with plan policy and working closely with the Quality Management team on credentialing, member complaints, and quality-of-care investigations. Maintaining accurate provider data and submitting timely reports on activities and outcomes is crucial, as is building effective partnerships across internal departments and stakeholders.
The position supports remote work flexibility but requires candidates to reside within Central or Eastern Time Zones, preferably near Pennsylvania, to maintain alignment with the organizational schedule and attend annual conferences as needed. The ideal candidate is a self-starter with excellent time management, problem-solving skills, and the ability to manage competing demands effectively. Strong collaboration skills are essential for working within cross-functional teams to advance network goals and improve care delivery.
This full-time role provides a rewarding career opportunity to contribute to a nationally recognized organization committed to health equity, quality care, and innovation in managed healthcare. AmeriHealth Caritas’s comprehensive benefits package supports your personal and professional well-being with health insurance from day one, paid time off including holidays and volunteer events, 401(k) plans, tuition reimbursement, and flexible scheduling options. Join AmeriHealth Caritas and make a meaningful impact on healthcare delivery in communities that need it most.
Job Requirements
- High school diploma or GED required
- 1-3 years of experience in a Provider Services role working directly with providers
- 3-5 years of experience in the managed care or health insurance industry
- reside in CST or EST time zone
- ability to travel to annual conferences
- strong communication and interpersonal skills
Job Qualifications
- Bachelor’s degree or equivalent experience preferred
- experience in a Provider Services role working directly with providers
- experience in the managed care or health insurance industry
- familiarity with Medicare, Medicaid, or ACA Exchange preferred
- strong problem-solving skills
- ability to establish and maintain trust-based partnerships
- effective collaboration with cross-functional teams
- excellent time management skills
- ability to work independently
- ability to balance competing demands across provider accounts, projects, and deadlines
Job Duties
- Serve as the primary liaison between the Plan and assigned providers, ensuring a thorough understanding of contract terms, provider needs, and performance expectations
- conduct tailored provider onboarding and educational sessions
- resolve issues to support provider engagement and satisfaction
- monitor network adequacy and ensure compliance with state and federal access standards across all product lines
- identify and recruit qualified providers in new and existing service areas, ensuring alignment with financial and contractual requirements
- analyze provider performance using Plan reports and metrics
- develop and implement improvement strategies based on data insights
- support corrective action processes, including provider terminations, in accordance with Plan policies
- collaborate with the Quality Management team on credentialing, re-credentialing, member complaints, and quality-of-care investigations
- maintain accurate provider data in Facets and coordinate updates with the Provider Maintenance Department
- prepare and submit timely reports on activities, metrics, and outcomes
- build and sustain effective partnerships with internal departments and stakeholders
Job Criteria
Experience
Mid Level (3-7 years)
Job Location
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