Provider Network Manager

What You'll Do

• 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 

• 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 

• 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

• 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 

•  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 

• 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 

• 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.