Network Intelligence & Implementation Consultant

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for reimbursement.

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.

Responsibilities:

Reporting to the Manager of Market Intelligence and Implementation, the Network Intelligence & Implementation Consultant will be a member of the business-centric team responsible for managing the coordination, implementation and deliverables for market launch. The consultant will oversee the activities for market strategy and plan design to support the market requirements before any contracting begins. This work starts when senior leadership has high interest in bidding for a contract. Some key components of a new market launch include business/market intelligence on:

• State requirements
• Provider targets
• Weak points
• Payment rules
• Pricing and configurations
• Business rules.

The consultant must collaborate with internal partners on benefit design, contract options and standard (default) agreement builds (e.g., configuration, network development, medical management, actuarial, plan leaders) and with external partners to delineate/interpret special handling , unique characteristics and deliverables set forth in the contract (e.g., Medicaid, government agencies, IDS, medical societies).

The Network Intelligence & Implementation Consultant will execute the accountabilities for new market launch and create tighter collaboration through effective planning and preparation. The work will be focused on three touch points:

• Market Strategy
• Plan Design
• Readiness for transition to plan operations.

Major Accountabilities:

• Leverages Corporate, Plan and Medicaid/Medicare resources to develop actionable goals and ensure action plan are implemented to achieve performance goals
• Defined point of contact for Corporate and Plan collaboration and agreement which will include IT, Network Management, Claims, Provider Data Management, Service Operations, and Information Management
• Develops and/or implement processes and data sharing structures to assure warm transfer and oversight
• Coordinates with internal and external partners on resources and processes to assure data integrity for new market
• Analyzes and monitor progress; facilitate alignment of administrative and operational activities for go-live implementation
• Influences Plan to adopt best practices and standardized workflows.

Education/ Experience:

• Bachelor’s Degree or equivalent work experience (see qualifications).
• Minimum 5 years in managed care with 3 years of recent experience in provider contracting/ relations/ consulting, contract administration, market operations or value-based environment and a Bachelor’s degree.
• Minimum 8 years in managed care with 3 years of recent experience in provider contracting/ relations/ consulting, contract administration, market operations or value-based environment and no degree.

Other Skills:

• Experience with new product, business and/or market launch.
• Business-facing experience with several categories: provider engagement, Finance, market leadership, auditing, contract negotiation/execution.
• Excellent oral and written communication with good presentation skills.
• Business and financial acumen in the health care field.
• Prior leadership experience a plus.
• Advance Excel knowledge required

Our Comprehensive Benefits Package

Flexible work solutions including remote options, hybrid work schedules, Competitive pay, Paid time off including holidays and volunteer events, Health insurance coverage for you and your dependents on Day 1, 401(k) Tuition reimbursement and more.