Provider Relations & Network Development Lead

American Health Partners; Columbus (IN); Hybrid; USD 70,000 - 100,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

PTO & holidays

TeleDoc 24/7

Disability plans

Employee Assistance Plan

401K

Referral program

Job summary

American Health Plans, a division of American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities and works with nursing home operators to manage medical risk and reduce avoidable hospitalizations.

The team collaborates with providers to ensure CMS adequacy, credentialing, and program education while supporting network development and service delivery to plan members nationwide.

Qualifications

• Experience in the health care field required.
• Prior experience in network development / network services preferred.
• Experience with Medicare Advantage plans or health care networks helpful.
• Bachelor's degree required.

Responsibilities

• Contract providers and essential vendors in current service areas to maintain CMS adequacy and provide necessary services for Plan members.
• Ensure providers meet credentialing requirements for their service lines.
• Educate providers on Health Plan functions and roles in caring for its membership.
• Provide ongoing educational updates as prescribed by CMS and Health Plan policies.
• Conduct education presentations of Health Plan providers to ensure understanding and commitment.
• Monitor, maintain and support provider relationships to ensure network coverage in all areas.
• 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.

Skills

Medical services knowledge

Provider relationship mgmt

Negotiation skills

Organization

Time management

Communication

Team player

Microsoft Office Suite

Education

Bachelor's degree

Tools

Microsoft Office Suite

Job description

American Health Plans, a division of American Health Partners Inc., operates I-SNPs for seniors in long-term care facilities and works with nursing home operators to manage medical risk and reduce avoidable hospitalizations.

The team collaborates with providers to ensure CMS adequacy, credentialing, and program education while supporting network development and service delivery to plan members nationwide.