American Health Partners Job - 30948102 | CareerArc
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Company: American Health Partners
Location: Dallas, TX
Career Level: Mid-Senior Level
Industries: Healthcare, Pharmaceutical, Biotech


Basic Function

Analyze assigned market needs, performs contracting functions, educates providers and provider service entities, maintain business relationships for the Health Plan(s), reports on provider and market changes, acts as a support for other service areas for the Health Plan(s).

Essential Responsibilities

Essential responsibilities include the following. Other duties may be assigned.

· Managing the negotiation and contracting providers and essential vendors to maintain CMS adequacy and providing necessary services in the care of the Plan members.

· Develop and maintain healthcare provider network in assigned region including contracting, credentialing, and educating on expectations and future activities.

· Insuring providers and essential vendors meet the credentialing requirements for their appropriate service lines.

· Educating providers on the overview of Health Plan(s) functions and roles in caring for its membership.

· To perform analysis of the Health Plan(s) provider network to maintain network adequacy on an ongoing basis.

· Understanding, educating and discussing basic financial analysis of current or potential contracts and payment arrangements with providers and their appropriate staff

· To work with and be involved in implementation as needed.

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

· Complete corporate assignments as assigned.

Position Qualifications

The requirements listed below are representative of the knowledge, skills, and/or abilities required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The qualifications express the minimum standards of education and/or experience for this position. Other combinations of education and experience, if evaluated and equivalent, may be taken into consideration.


· Bachelor's degree with preferred, but not required, emphasis in Healthcare Administration/related field or three years of experience in managed care network development/network services.


· Must be fluent in all current provider payment methodologies.

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


· Experience in the health care field required.

· Prior experience in network development / network services is preferred.

· Prior experience with acute and post-acute facilities is beneficial.

· Prior experience with Medicare Advantage plans is helpful.

Skills and Abilities

· 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 all levels of medical staff to explain 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.

Work and Time Requirements

· Must be available to work 8 a.m. until 5 p.m. local time

· Position requires travel to network provider locations.

· Teleworking is an option if criteria are met.

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