Healthcare Provider Network Architect

American Health Plans; Franklin (TN); Hybrid; USD 85,000 - 120,000; Full time

Benefits offered by this job

Health insurance

PTO & holidays

TeleDoc access

Disability insurance

EAP

401K match

Referral bonus

Job summary

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., operates I-SNPs and Medicare Advantage plans across multiple states. The Provider Network Manager will build CMS-compliant networks, negotiate provider contracts, and maintain strong provider relationships while supporting new market implementations.

The role emphasizes strong negotiation, organization, and communication with medical staff, plus travel to provider locations.

Qualifications

• Bachelor’s degree or equivalent work experience.
• Five (5) plus years of experience in managed care/network development/ network services.
• Experience in the health care field required.
• Prior experience with Medicare Advantage plans is helpful.
• Prior experience in network development/network services is required.
• Prior experience with acute and post-acute facilities is beneficial.

Responsibilities

• 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.

Skills

Negotiation

Organization

Presentation

Time management

Communication with medical staff

Teamwork

Self-motivated

Education

Bachelor’s degree or equivalent work experience

Job description

American Health Plans, a division of Franklin, Tennessee-based American Health Partners Inc., operates I-SNPs and Medicare Advantage plans across multiple states. The Provider Network Manager will build CMS-compliant networks, negotiate provider contracts, and maintain strong provider relationships while supporting new market implementations.

The role emphasizes strong negotiation, organization, and communication with medical staff, plus travel to provider locations.