Provider Network Account Executive II

Role OverviewThe Provider Network Account Executive II (AE II) is responsible for developing strategic direction and managing day-to-day network activities for all provider types, including single or multiple practices, integrated delivery systems, and other provider organizations. This role involves understanding the Plan’s contracts and provider performance, conducting tailored orientation sessions, educational visits, and resolving provider issues. The AE II ensures appropriate access to services across the Plan’s territory, adhering to State and Federal mandates for all products.Work ArrangementRequires 10% to 25% travel to provider office within Ohio as well as to our Dublin, Ohio officeHybridQualified candidates must reside in the state of OhioResponsibilitiesMonitor and manage the provider network to ensure service accessibility and compliance with mandatesIdentify, contact, and solicit qualified providers to join the Plan, maintaining financial integrity and contract requirementsUse plan reports and metrics to evaluate and improve provider performanceDevelop methods to enhance provider relationships and assist in corrective actions as neededAssist with credentialing, re-credentialing, and investigating member complaints and quality issuesMaintain knowledge of Facets and relay provider database updates to the Provider Maintenance DepartmentDeliver accurate, timely activity and metric reportsBuild strong partnerships with internal resources and stakeholdersHighly effective communicator, comfortable with public speaking and presenting to leadership and executive teamsNurture provider partnerships and seek value-based business opportunities to support local market strategyRecruit providers to meet network adequacy targetsResolve complex provider service complaints and negotiate solutionsEnsure accurate contract loading and submissions and manage network implementation and maintenanceManage ongoing projects or programs within the Provider Network Management organizationDevelop and implement provider education programs and materials, and train new AEsSupport of Value-Based Contracting (VBC) negotiations; lead in VBC relationships; may lead negotiationsConsults on VBC contracts, facilitates for success (JOCs, performance overview, etc.) with specific bonuses attached to performance improvementResponsible to maintain and manage VBC requirements, including but not limited to; monitoring performance standards against VBC or State program requirements, working with key stakeholders and provide oversight on applicable data-sharing or report requirementsAssist AE I in managing provider issues;Education and ExperienceBachelor's degree required5 to 10 years of substantive Account Executive experience with high-impact provider groups3 to 5 years in VBC, Provider Services, including network management and recruitment required5 to 10 years in managed care/health insuranceLicensure;Valid driver’s license and automobile insurance requiredSkills & AbilitiesIndependent project management, training and mentoring, executive-level interaction, claims processing/billing knowledge, payment methodologies, and network managementYour career starts now. We are looking for the next generation of healthcare leaders.At AmeriHealth Caritas, we are 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 would like to connect with 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. 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 .;Our Comprehensive Benefits PackageFlexible 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 one, 401(k) tuition reimbursement, and more.#HM

Created: 2025-07-01