Provider Network Strategist - Hybrid, Competitive Benefits

American Health Partners; Franklin (TN); Hybrid; USD 85,000 - 125,000; Full time

Benefits offered by this job

Medical/Dental/Vision insurance

Paid time-off & holidays

TeleDoc 24/7/365 access

Disability plans (short & long-term)

Employee Assistance Plan (EAP)

401K with company match

Employee Referral Program

Job summary

American Health Plans, a division of American Health Partners Inc., seeks a Provider Network Manager to establish CMS-compliant, cost-efficient provider networks across assigned markets by negotiating agreements with healthcare providers. You will maintain positive relationships with contracted providers and report on market changes while serving as a SME across the organization.

This role supports expansion efforts and ensures credentialing standards are met.

Qualifications

• Bachelor’s degree or equivalent work experience.
• 5+ years in managed care, network development or network services.
• Experience in the health care field required; Medicare Advantage experience is helpful.
• Experience with acute and post-acute facilities is beneficial.

Responsibilities

• Establish CMS-compliant, cost-effective provider networks in assigned markets.
• Negotiate provider agreements and ensure CMS network adequacy standards.
• Ensure providers meet credentialing requirements.
• Analyze provider networks and maintain network adequacy.
• Support implementation of Health Plans in new markets as needed.
• Foster process improvements and collaborate across departments.

Skills

Negotiation

Communication

Project management

Microsoft Office

Independent work

Education

Bachelor's degree or equivalent

Tools

Credentialing software

Health Plan systems

Job description

American Health Plans, a division of American Health Partners Inc., seeks a Provider Network Manager to establish CMS-compliant, cost-efficient provider networks across assigned markets by negotiating agreements with healthcare providers. You will maintain positive relationships with contracted providers and report on market changes while serving as a SME across the organization.

This role supports expansion efforts and ensures credentialing standards are met.