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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 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 .

The Vice President, Provider Network Management, is responsible for developing and overseeing high-performing provider networks across all product lines, including Medicaid, Medicare, and the Health Insurance Marketplace (Exchange). This role manages teams that handle contracting and relationships with hospitals, physicians, specialists, and other healthcare providers. The Vice President ensures alignment with enterprise goals, strengthens provider partnerships, and supports overall network performance. This position works closely with senior executives across the healthcare system, including chief executive officers, chief financial officers, and directors of managed care leadership.

Responsibilities:

+ Lead the development and execution of market-specific network strategies that support Medicaid, Medicare, and Exchange product lines, including network design, contract negotiations, and regulatory compliance.

+ Oversee contracting efforts across all provider types—hospitals, physicians, specialists, ancillary providers, federally qualified health centers (FQHCs), and rural health clinics (RHCs)—ensuring adherence to pricing, payment methodologies, and state/federal requirements.

+ Cultivate high-performing, cost-effective provider networks that support access, quality, and clinical outcomes while ensuring compliance with network adequacy standards.

+ Direct provider engagement strategies that promote collaboration, satisfaction, and shared performance goals, including value-based payment models and alternative reimbursement arrangements.

+ Serve as a strategic advisor to executive leadership on emerging trends in provider network management, reimbursement policy, regulatory shifts, and market competitiveness.

+ Partner with leaders in medical economics, finance, compliance, clinical operations, legal, and quality to align provider goals with broader enterprise initiatives.

+ Lead the design and execution of provider performance improvement plans using data insights, utilization patterns, claims analysis, and quality metrics.

+ Resolve provider escalations and oversee claim issue resolutions, provider communications, education, and onboarding.

+ Recruit, coach, and lead a high-performing provider network team with a focus on accountability, collaboration, and innovation.

Education & Experience:

+ Bachelor’s degree in Business, Healthcare Administration, Healthcare Management, or a related field is required; a Master’s degree is strongly preferred.

+ A minimum of 10 years of progressive experience in managed care with direct accountability for provider contracting, reimbursement strategy, and network development across Medicaid, Medicare, and Exchange (Health Insurance Marketplace) products.

+ At least 2 years of hands-on experience working with Medicaid provider contracts; additional expertise in Medicare Advantage and Exchange plans is highly desirable.

+ 8 to 10 years of senior-level leadership experience, including successful oversight of large-scale provider networks and enterprise contract negotiations.Minimum of 5 years of proven success in leading cross-functional teams across multiple geographic locations and remote environments, including managers, coordinators, and account executives.

+ Deep knowledge of reimbursement methodologies, value-based payment models, regulatory standards, and provider network adequacy requirements.

+ Strong business and financial acumen with the ability to analyze data, synthesize insights, and drive strategic decisions.

+ Exceptional communication, negotiation, and relationship-building skills, with a demonstrated ability to influence stakeholders and navigate complex provider dynamics.

+ Technologically adaptable, with experience leading or supporting digital initiatives to enhance provider operations and streamline workflows. (i.e., Facets and Salesforce)

Diversity, Equity, and Inclusion

At AmeriHealth Caritas, everyone can feel valued, supported, and comfortable to be themselves. Our commitment to equity means that all associates have a fair opportunity to achieve their full potential. We put these principles into action every day by acting with integrity and respect. We stand together to speak out against injustice and to break down barriers to support a more inclusive and equitable workplace. Celebrating and embracing the diverse thoughts and perspectives that make up our workforce means our company is more vibrant, innovative, and better able to support the people and communities we serve.

We keep our associates happy so they can focus on keeping our members healthy.

Our Comprehensive Benefits Package

Flexible 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 1, 401(k) tuition reimbursement, and more.

As a company, we support internal diversity through:

Recruiting. We are an equal opportunity employer. We do not discriminate on the basis of age, race, ethnicity, gender, religion, sexual orientation, or disability. Our inclusive, equitable approach to recruiting and hiring reinforces our commitment to DEI.