Top Provider Network Executive jobs in Charlotte, NC

Top Provider Network Executive plans and directs all aspects of an organization's provider network function. Responsible for developing the network and negotiating and administering contracts. Being a Top Provider Network Executive oversees provider relations and monitors and directs all provider services. Requires a bachelor's degree. Additionally, Top Provider Network Executive typically reports to a top management. The Top Provider Network Executive manages a departmental function within a broader corporate function. Develops major goals to support broad functional objectives. Approves policies developed within various sub-functions and departments. To be a Top Provider Network Executive typically requires 8+ years of managerial experience. Comprehensive knowledge of the overall departmental function. (Copyright 2024 Salary.com)

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Provider Network Account Executive II
  • AmeriHealth Caritas Health Plan
  • Charlotte, NC FULL_TIME
  • Your career starts now. We are looking for the next generation of health care 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 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 would like to connect with 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.

    Responsibilities:

    The AE II is responsible for building, nurturing and maintaining positive working relationships between AmeriHealth Caritas North Carolina (AHNC) and its contracted providers.  Assigned provider accounts may include single or multiple practices in single or multiple locations, integrated delivery systems or other provider organizations.  AE II maintains in depth understanding of ACNC’s contracts and provider performance and needs, identifying, developing and conducting relevant and tailored provider orientation sessions, making educational visits and working to resolve provider issues.  Responsible for monitoring and managing provider network by assuring appropriate access to services throughout the ACNC’s territory in keeping with State and Federal contact mandates for all products.  Identifies, contacts and actively solicits qualified providers to participate in ACNC at new and existing service areas and products, assuring financial integrity of the ACNC is maintained and contract management requirements are adhered to, including language, terms and reimbursement requirements.  Maintains complete understanding of ACNC reports and metrics and uses them to evaluate the performance of assigned providers/practices/facilities, determining, communicating and implementing plans for providers to improve performance and measuring ongoing performance.  Supports the credentialing and re-credentialing processes, investigation of member complaints and any potential quality issues.  Maintains a functional working knowledge of Facets, including the provider database integrity. Identifies and maintains strong partnerships with appropriate internal stakeholders.  

    An AE II’s accounts/assignments include:

    • Large health systems.
    • High spend providers with multiple practice locations and/or multiple specialties.

    The AE II is responsible for developing/implementing/managing ongoing Provider Network Management projects, as needed.  

    The AE II is responsible for participating or independently developing and implementing Provider Network education programs and materials (both internal and provider targeted) and is assigned to train, mentor and support new AE’s. The AE II will assist AE I’s in resolving/managing issues with Providers.

    Education/Experience: 

    • Bachelor’s Degree or equivalent education and experience required.
    • 3 to 5 years contract negotiation experience preferred.
    • 3 to 5 years experience in a Provider Services position working with Health Systems.     
    • 5 to 10 years experience in the managed care/health insurance industry with demonstrated strengths in: knowledge of Plan policies and procedures related to provider complaint resolution, provider credentialing, provider billing and payment, provider incentive programs and other key State and Federal regulatory requirements related to providers, claim adjudication systems, provider file database requirements and relevant software applications;  working independently and managing complex projects and programs both as an independent owner and team leader, training and mentoring skills, interacting at an executive level internally and externally.  
    • Substantive Senior Account Executive experience with high impact, high dollar, extremely visible and critical provider groups.
    • Medicaid experience required and ACA Exchange experience preferred.
    • This is a 100% remote position. Finalist can reside anywhere in North Carolina (Charlotte Metro preferred).

     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 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.

  • 4 Days Ago

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Provider Network Account Executive II
  • AmeriHealth Caritas Health Plan
  • Charlotte, NC FULL_TIME
  • Your career starts now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well and build healthy communities....
  • 4 Days Ago

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Network Segmentation Architect
  • Hispanic Technology Executive Council
  • Charlotte, NC FULL_TIME
  • About Us:At Bank of America, we are guided by a common purpose to help make financial lives better through the power of every connection. Responsible Growth is how we run our company and how we delive...
  • 16 Days Ago

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Lab Services Network Engineer
  • Hispanic Technology Executive Council
  • Charlotte, NC FULL_TIME
  • Position SummaryBank of America is seeking an FTE within the Innovation Lab Services team, with proven expertise in managing complex network systems programs and delivering on complex initiatives. Thi...
  • 7 Days Ago

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Network Security Assurance & Remediation Engineer
  • Hispanic Technology Executive Council
  • Charlotte, NC FULL_TIME
  • The Cyber Security Assurance (CSA) Organization is responsible for providing an uncompromised technology and application environment for employees, customers, clients, and shareholders through continu...
  • 1 Month Ago

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Data Center and DMZ Network Engineer (Implementation)
  • Hispanic Technology Executive Council
  • Charlotte, NC FULL_TIME
  • About Us:At Bank of America, we are guided by a common purpose to help make financial lives better through the power of every connection. Responsible Growth is how we run our company and how we delive...
  • 1 Month Ago

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0 Top Provider Network Executive jobs found in Charlotte, NC area

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Chief Executive Officer
  • BNI Global LLC
  • Charlotte, NC
  • Job Description Job Description About BNI Founded in 1985, BNI is the recognized worldwide leader in business networking...
  • 4/22/2024 12:00:00 AM

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Chief Executive Officer
  • Jewish Federation Of Greater Charlotte
  • Charlotte, NC
  • The Opportunity For 85 years, the Jewish Federation of Greater Charlotte (JFGC) has and continues to play a pivotal role...
  • 4/22/2024 12:00:00 AM

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Chief Executive Officer
  • Jewish Federation of Greater Charlotte
  • Charlotte, NC
  • The Opportunity For 85 years, the Jewish Federation of Greater Charlotte (JFGC) has and continues to play a pivotal role...
  • 4/20/2024 12:00:00 AM

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Partnership Executive
  • Fusion Growth Partners
  • Charlotte, NC
  • About the Company Fusion Growth Partners is a business incubator and micro venture capital company. We invest in busines...
  • 4/20/2024 12:00:00 AM

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Executive Chef I
  • Windsor Run by Erickson Senior Living
  • Matthews, NC
  • Location: Windsor Run by Erickson Senior Living Windsor Run is a beautiful 60-acre continuing care retirement community ...
  • 4/19/2024 12:00:00 AM

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Executive Assistant Office Manager
  • The Storick Group
  • Newton, NC
  • Job Description Job Description We are looking to hire an Executive Assistant Office Manager to join our team! You will ...
  • 4/19/2024 12:00:00 AM

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Account Executive
  • US Foods, Inc.
  • Charleston, SC
  • ESSENTIAL DUTIES AND RESPONSIBILITIES Develop and maintain existing accounts through personal visits and follow-up on a ...
  • 4/19/2024 12:00:00 AM

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Executive Chef
  • Aramark
  • Concord, NC
  • Job Description The Executive Chef is a management position overseeing chef managers as well as hourly culinary staff, r...
  • 4/11/2024 12:00:00 AM

Charlotte (/ˈʃɑːrlət/) is the most populous city in the U.S. state of North Carolina. Located in the Piedmont, it is the county seat of Mecklenburg County. In 2017, the U.S. Census Bureau estimated the population was 859,035, making it the 17th-most populous city in the United States. The Charlotte metropolitan area's population ranks 22nd in the U.S., and had a 2016 population of 2,474,314. The Charlotte metropolitan area is part of a sixteen-county market region or combined statistical area with a 2016 census-estimated population of 2,632,249. Between 2004 and 2014, Charlotte was ranked as...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Top Provider Network Executive jobs
$384,001 to $711,085
Charlotte, North Carolina area prices
were up 1.5% from a year ago