163396 - Provider Relations / Network Management Specialist

Title: Provider Relations / Network Management SpecialistLocation: Hybrid – Remote / Field (Local travel 4 days/week)Salary: $86,000 – $154,700 per year potential 8% annual bonusBenefits: Competitive health insurance, 401(k) with company match, stock purchase plans, tuition reimbursement, paid time off & holidays, flexible work arrangements (remote, hybrid, field, office).Job Description:We are seeking a Provider Relations / Network Management Specialist to develop strategic partnerships between the health plan and contracted provider networks. In this role, you will cultivate provider relationships, support performance improvement initiatives, and ensure the highest quality of care for members.Key Responsibilities:Conduct regular in-person visits with physicians to provide real-time support, discuss performance metrics, and identify opportunities for improvement in patient care and clinical practices.Support value-based care model initiatives, aligning providers to performance-based agreements that incentivize better patient outcomes, cost-efficiency, and quality care.Track and analyze provider performance using data analytics and provide actionable insights.Build strong relationships with external providers and internal cross-functional teams.Educate providers on policies, procedures, referrals, claims submission, EDI, and value-based performance tools.Investigate and resolve high-dollar or high-volume provider claim issues.Develop and implement strategic plans to improve provider performance.Present analyses and reports for Joint Operating Committee meetings (JOC).Lead and coach external representatives.Travel locally up to 4 days per week as required.Qualifications:Required: Bachelor’s degree in a related field or equivalent experience.Preferred: Master’s degree in Public Health (MOH), Health Administration (MHA), or Business Administration (MBA).Minimum 3–5 years of experience in managed care, medical groups, provider relations, quality improvement, utilization management, or clinical operations.Project management experience in a health plan, IPA, or medical group setting.Executive-level exposure with the ability to influence outcomes and drive performance improvement.Strong knowledge of HEDIS/quality measures, cost, utilization, and value-based care initiatives.Excellent interpersonal, communication, and problem-solving skills.Valid driver’s license required.Why Join Us:You’ll have the opportunity to make a meaningful impact on healthcare delivery while enjoying competitive benefits, flexible work options, and career growth opportunities.To Apply:Submit your application directly through ZipRecruiter. No cover letter required.

Salary : $86,000 - $154,700