Vice President Provider Network Management

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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.

Job Summary

The Vice President, Provider Network Management serves as the enterprise leader for provider contracting and network management activities across markets and lines of business and is a key leader in shaping provider network strategy. This role is responsible for ensuring the development, optimization, and maintenance of compliant, high-performing provider networks that meet access, adequacy, quality, and service requirements for members. The Vice President partners closely with market and corporate leadership to establish network strategy, contracting approaches, operational controls, and provider engagement models that support organizational growth and performance objectives. This role also leads cross-functional collaboration with business development, pricing, actuarial, operations, provider relations, claims, sales, marketing, and technology teams to ensure provider network strategy is aligned with business needs and regulatory requirements. This leader will also be responsible for leading the Indiana provider network strategy.

The Vice President is expected to lead multiple functions, manage network management resources, and act as a senior decision-maker for contracting and network-related activities. The role requires close coordination across business domains and strong oversight of staff productivity, provider relationships, and contracting outcomes.

Essential Functions:

• Support market leaders with network tooling, adequacy standards, and contracting strategies.
• Lead the Indiana provider network strategy, including network expansion, optimization, and market-specific contracting priorities.
• Develop long-term strategies for network growth and optimization, addressing gaps in service coverage and ensuring the network adapts to changing healthcare trends and member needs.
• Utilize market trends and data to inform network strategy and identify opportunities for growth and improvement.
• Ensure the development and maintenance of a comprehensive provider network, including hospitals, physicians, and ancillary providers.
• Demonstrate shared leadership in the overall insurance business by balancing the need to provide a broad network of services with controlling costs for both the company and members through strong unit cost guidelines and contracting parameters.
• Monitor network adequacy and compliance with all applicable regulatory and accreditation requirements.
• Monitor and evaluate network performance, addressing gaps and opportunities for improvement.
• Provide central management of contract inventory, renewals, and amendments, ensuring all agreements are current and compliant with organizational policies and regulations.
• Provide guidance and support in contract negotiations and network management activities across markets.
• Lead provider operations functions such as credentialing, contract configuration, and provider data management.
• Ensure a cohesive provider experience through leadership of provider success, provider communications, and provider marketing, including partnership with Provider Relations, Claims, and other operational areas.
• Collaborate with business development, sales, marketing, operations, pricing, actuarial, value-based performance, legal, and market leadership to align network strategy with organizational goals and market needs.
• Partner with technology teams to develop and enhance tools, workflows, and processes required to support provider network management and operations.
• Lead all aspects of the contracting process from strategy through execution across lines of business.
• Establish and maintain contract templates, operational controls, and governance practices consistent with organizational and legal requirements.
• Ensure compliance with all applicable federal and state laws, regulations, and internal policies.

Education/Experience:

• ☒Bachelor’s Degree.
• Master's Degree preferred.
• 15 or more years of network management experience15 or more years of network management experience.

Other Skills:

• Experience partnering with technology teams to optimize and evolve operational programs.
• Demonstrated success in growing and optimizing provider networks.
• Experience leading enterprise or multi-market provider contracting strategies.
• Strong understanding of federal and state-specific contracting requirements and network adequacy expectations.