Provider Network Manager en American Health Plans / American Health Partners Inc.

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc. owns and operates Institutional Special Needs Plans (I-SNPs) for seniors who reside in long-term care facilities. In partnership with nursing home operators, these Medicare Advantage plans manage medical risk by improving patient care to reduce emergency room visits and avoidable hospitalizations. This division currently operates in Tennessee, Georgia, Missouri, Kansas, Oklahoma, Utah, Texas, and Mississippi, Louisiana, Iowa, and Idaho with planned expansion into other states in 2024. For more information, visit AmHealthPlans.com. 

If you would like to be part of a collaborative, supportive and caring team, we look forward to receiving your application! 

Benefits and Perks include:

• Affordable Medical/Dental/Vision insurance options
• Generous paid time-off program and paid holidays for full time staff
• TeleDoc 24/7/365 access to doctors
• Optional short- and long-term disability plans
• Employee Assistance Plan (EAP)
• 401K retirement accounts
• Employee Referral Bonus Program

The Provider Network Manager is primarily responsible for establishing CMS-compliant, cost-effective and competitive healthcare provider networks in assigned markets by negotiating agreements with healthcare providers.  Responsibilities also include maintaining positive business relationships with contracted providers and reporting on material changes in assigned markets while serving as a subject matter expert (SME) for other functional areas within the organization.

ESSENTIAL FUNCTIONS:

To perform this job, an individual must accomplish each essential function satisfactorily, with or without reasonable      accommodation.

• Execute agreements with healthcare providers & essential vendors in assigned markets to establish competitive and cost-effective healthcare provider networks, which also meet CMS network adequacy standards.   

• Ensure providers and essential vendors meet the credentialing requirements 

• Analyze the Health Plan(s) provider network to maintain network adequacy on an ongoing basis

• Support implementation of Health Plan(s) in new markets as needed

• Establish a positive work environment that encourages participation in process improvement and commitment to department/company success

• Complete corporate assignments, including but not limited to compliance training, as assigned

JOB REQUIREMENTS:

• Must have knowledge and familiarity with all levels of medical services and ability to rapidly develop working relationships

• Must be able to accept instructions and work independently in the completions of goals and assignments

• Must have strong negotiation, organization, presentation, and time management skills

• Must be able to effectively communicate with medical staff to explain the Health Plan(s) program, benefits, and  goals

• Must be able to work effectively in a team environment

• Excellent computer skills, including Microsoft Office Suite

• Must be self-motivated, dependable, team and goal oriented

• Successful completion of required training

• Handle multiple priorities effectively

• Independent discretion/decision making

• Reliable transportation

• Current automobile insurance according to company policy

Required Computer Software/Equipment used:

• Various operating systems

• Standard office equipment

• Microsoft Suite applications

• Desktop, laptop and/or iPad

REQUIRED QUALIFICATIONS:

• Education:

o Bachelor’s degree or equivalent work experience

o Five (5) plus years of experience in managed care/network development/ network services

• Experience:

o Experience in the health care field required

o Prior experience with Medicare Advantage plans is helpful

o Prior experience in network development/network services is required

o Prior experience with acute and post-acute facilities is beneficial

EQUAL OPPORTUNITY EMPLOYER

Our Organization does not discriminate based on race, color, religion, sex, handicap, disability, age, marital status, sexual orientation, national origin, veteran status, or any other characteristic(s) protected by federal, state, and local laws. The Organization will also make reasonable accommodations for qualified individuals with disabilities should a request for an accommodation be made.

This employer participates in E-Verify.