Director Provider Network Development Jobs in Windermere, FL

Job Summary:

The primary responsibility of Account Executive is to develop strong relationships with providers to drive for performance, specifically as it relates to core providers as determined by the program who are in fee for service programs and may include PCPs, OB/GYNs, high volume specialists, and FQHCs.

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 building, nurturing, and maintaining positive working relationships between Plan and its contracted providers
• Resolve Provider disputes in a timely and compliant manner
• Servicing assigned provider accounts which may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations
• Uses data to develop and implement methods to improve relationship
• Perform site visits as needed
• Maintains a functional working knowledge of Facets, including the provider database and routinely relays information about additions, deletions or corrections
• Identifies and maintains strong partnerships with appropriate internal resources and stakeholders
• 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.
• Maintains in depth understanding of Plan's contracts and provider performance and needs, identifying, and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues
• Assist with recruiting providers based on identified network adequacy gaps (high complexity)
• Support contracting for multiple product lines, including LTSS, Exchange, DSNP could be asked to complete straightforward FFS contracts
• Support of VBC relationships and negotiations where needed

Work Arrangement: Remote; Field-Based

• Remote, field-based position requiring regular travel throughout assigned regions in Florida, including Lake, Orange, Osceola, Seminole, Polk, Pasco, Pinellas, and Hillsborough counties.
• Conduct provider outreach, relationship management, education, training, onboarding, and on-site provider visits within the designated service areas.
• Valid driver's license, current automobile insurance, and reliable personal transportation are required.

Education & Experience:

• High school diploma or GED required; bachelor's degree preferred. Equivalent combination of education and relevant experience will be considered.
• Minimum of 1-3 years of Provider Services experience working directly with healthcare providers.
• Demonstrated experience delivering provider education, training, onboarding, and presentations to large groups.
• Minimum of 3-5 years of experience in the managed care, health insurance, or healthcare industry.
• Knowledge of and experience supporting Medicare, Medicaid, and/or Affordable Care Act (ACA) Exchange programs preferred.

Preferred Skills:

• Experience building and maintaining effective provider relationships.
• Strong presentation, facilitation, and public speaking skills.
• Ability to educate providers on policies, procedures, regulatory requirements, and operational processes.
• Excellent communication, organizational, and customer service skills.
• Proficiency with Microsoft Office applications and provider-facing systems preferred.

Our Comprehensive Benefits Package

We offer flexible work solutions, including remote options and hybrid schedules, competitive pay, paid time off (including holidays and volunteer events), health insurance coverage for you and your dependents starting Day 1, 401(k), tuition reimbursement, and more.

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 millions of lives through our national footprint of products, services, and award-winning programs. If you want to make a difference, we'd love to hear from you.

Headquartered in Newtown Square, PA, 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. Our offerings include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us atwww.amerihealthcaritas.com