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The LTSS Director of Provider Network Management is accountable for leading the development and management of our long-term services and supports (LTSS) and home and community-based services (HCBS) networks for our Pennsylvania Community HealthChoices (CHC) managed long-term services and supports (MLTSS) Medicaid plan provider network. The CHC program serves adults aged 21 and older who are eligible for Medicaid and need LTSS services at a nursing facility level of care (either in the home with HCBS services or in a facility), including both Medicaidonly and dualeligible (Medicare and Medicaid) individuals.

Reporting to the CHC VP of Plan Operations, this role ensures that the CHC KF/ACPA LTSS network development and governance infrastructure functions effectively and efficiently. This role supports the CHC market in developing and executing its LTSS network strategy at the local level and collaborates with shared service/functional partners to lead market-specific strategic initiatives that align with contractual/regulatory requirements, business priorities, and stakeholder needs. This position interacts with LTSS and HCBS provider Chief Executive Officers, Chief Financial Officers, Directors of Managed Care, and other high-level executives.

Work Arrangement: Remote with required travel to Harrisburg, PA and Ellis Preserve offices on a regular basis. Must be able to accommodate working during Eastern Time Zone.

Responsibilities:

• Network Strategy and Oversight:
  • Accountable for the development and execution of strategic planning for LTSS and HCBS network development and management.
  • Lead the development and execution of the LTSS/HCBS network strategy to ensure sufficient provider capacity, participant access, geographic coverage, service availability, and compliance with CHC program requirements.

  • Oversee network planning for core LTSS/HCBS service categories, including but not limited to personal assistance services, home health, adult day services, residential habilitation, service coordination-related provider interfaces, participant-directed services, durable medical equipment, home modifications, emergency response systems, transportation-related supports, and other community-based services.

• Provider Contracting and Negotiations:

  • Oversee LTSS/HCBS provider contracting strategy, including contract development, rate negotiations, contract amendments, provider terminations, new provider onboarding, and value-based payments (VBP).
  • Ensure provider contracts align with state Medicaid requirements, health plan policies, value-based care priorities, quality expectations, claims requirements, credentialing standards, and operational performance expectations.
  • Lead or support negotiations with high-impact providers, including large home care agencies, adult day, residential providers, specialized LTSS providers, and regional provider organizations, among others.
• Regulatory and Compliance Alignment
  • Ensure providers receive timely guidance regarding contractual requirements, claims processes, authorization protocols, Electronic Visit Verification (EVV) expectations, quality initiatives, and regulatory changes.
  • Ensure the LTSS/HCBS provider network meets all applicable state, contractual, and internal network adequacy standards.
  • Lead ongoing monitoring of access indicators, including provider availability, service initiation timeliness, geographic coverage, specialty service gaps, participant complaints, grievance trends, authorization delays, and service interruption risks.

• Provider Engagement, Relationship Management, and Performance Management:
  

  • Build and maintain effective relationships with LTSS/HCBS providers, provider associations, community organizations, advocacy groups, and state partners.
  • Lead provider engagement strategies that promote transparency, responsiveness, operational clarity, and shared accountability for participant outcomes.
  • Oversee LTSS/HCBS provider forums, trainings, communications, issue-resolution processes, and escalation pathways
• Team Leadership and Talent Development:
  • Foster team engagement and growth through consistent coaching, mentorship, and performance evaluations, supporting career development while addressing performance gaps in a timely and effective manner.
  • Responsible for departmental staffing decisions and providing supervision to assigned staff, writes and performs annual reviews, and monitors performance issues as they arise.
  • Establish clear goals, accountability structures, workflows, and performance expectations for direct reports and functional teams.
    Foster a culture of collaboration, regulatory discipline, provider partnership, operational excellence, and continuous improvement.

Education/Experience:

• Bachelor's degree (or equivalent experience) in Business or health related disciplines such as Healthcare Administration or Healthcare management or equivalent business experience.
• 8 to 10 years of progressive business management.
• 5 to 10years Managed Care industry experience including contracting and reimbursement experience.
• 5 or more years people management experience, managing teams and project management.
• 3 years Medicaid and long term services and support (LTSS) and home and community based service (HCBS)experience required; new program implementation experience preferred; knowledge base of Medicare crossover claims set up and oversight required.
• A valid driver's license and current auto insurance required.

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.

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

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.