Provider Network Manager

Department: Market Ops - APC

Location: 9700 Flair Drive, El Monte, CA 91731

Compensation: $75,000 - $88,000 / year

Description

About the Role:
The Provider Network Manager is responsible for managing and optimizing assigned segments of the provider network to ensure adequate access, strong provider performance, and alignment with organizational quality, financial, and growth objectives. This role serves as a key operational and relationship manager for physicians, IPAs, hospitals, and ancillary providers and acts as a primary point of contact for network-related issues within the assigned market. This position does not have direct reports but plays a critical role in influencing outcomes through collaboration with internal partners and external provider organizations.

What You'll Do

Provider Network Management & Optimization

• Manage day-to-day performance and relationships for assigned providers, IPAs, hospitals, and specialty networks
• Monitor network adequacy, access standards, panel capacity, and geographic coverage to support membership growth and retention
• Identify network gaps, capacity constraints, and performance risks; recommend corrective actions to leadership

Provider Performance & Quality Support

• Support provider performance related to quality measures, utilization, and value-based care initiatives
• Collaborate with Quality, Medical Management, and Analytics teams to reinforce quality programs, incentive alignment, and performance improvement efforts
• Assist in driving improvement in key metrics such as HEDIS, STARS, utilization management, and member experience

Contract & Network Operations Support

• Partner with Contracting and Credentialing teams to support provider onboarding, terminations, network expansions, and contract implementation
• Ensure accurate provider data, network directories, and system configuration in collaboration with operations teams
• Support execution of provider incentive programs and contract-related initiatives

Provider Relations & Issue Resolution

• Serve as a primary escalation point for provider network issues, including access, operational challenges, and performance concerns
• Facilitate effective communication between providers and internal teams to resolve issues efficiently and maintain strong provider relationships
• Support preparation and participation in Joint Operating Committee (JOC) meetings and provider governance forums

Regulatory & Compliance Support

• Ensure network management activities comply with health plan requirements and state and federal regulations (e.g., DMHC, CMS)
• Support audits, regulatory submissions, and delegated risk requirements related to network operations
• Maintain documentation and reporting to support compliance and operational readiness

Cross-Functional Collaboration

• Partner closely with internal stakeholders including Medical Management, Quality, Claims, DSS/Analytics, Finance, Customer Service, and Government Programs
• Support implementation of network policies, workflows, and process improvements
• Provide market and provider insights to inform broader network strategy and leadership decision-making Performs other duties as assigned by the department leaders
• Other duties as assigned
  
  

Qualifications

• Bachelor’s degree in Healthcare Administration, Business, Public Health, or a related field
• At least 5 years of experience in provider network management, provider relations, or managed care operations
• Have experience working with physician networks, IPAs, hospitals, or health plans
• Strong understanding of managed care, delegated risk models, and provider network operations

You're great for the role if:

• Have experience working with delegated risk or value-based care models
• Experience in California managed care markets
• Familiarity with DMHC access standards, CMS requirements, and delegated risk oversight
• Advanced degree (MBA, MHA, MPH) a plus
  
  

Environmental Job Requirements and Working Conditions

• Our organization follows a regional/hybrid work structure where the expectation is to work both in office and visiting provider offices on a weekly basis. The office is located at 9700 Flair Drive, El Monte, CA 91731.
• The total compensation target pay range for this role is: $75,000 - $88,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.

Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action Employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation.

Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.