Provider Relations Manager
$105,000–$119,000 year
HybridHenderson, Nevada, United States
Job Summary
Develop and maintain collaborative relationships with contracted primary care providers, clinic leadership, office managers, and practice staff across the provider network. Serve as the primary operational liaison to facilitate communication, resolve issues, and support value-based care initiatives by partnering with Care Management, Quality, and Claims Operations. Conduct routine office visits to assess operational needs, educate providers on HEDIS, STARS, and clinical documentation, and coordinate the implementation of new policies and regulatory requirements. Investigate and resolve provider concerns regarding claims, authorizations, and eligibility while analyzing performance metrics to identify improvement opportunities. Support onboarding for new providers and participate in cross-functional committees to drive organizational objectives. Maintain documentation of all interactions and ensure compliance with federal, state, and contractual requirements. This hybrid role requires three days in the office per week and the ability to travel to engage with physician teams and build network relationships.
Required Qualifications
- Knowledge of provider relations, managed care operations, delegated healthcare models, and value-based care principles
- Understanding of Medicare Advantage, population health, HEDIS, STARS, Risk Adjustment, Clinical Documentation Improvement (CDI), and quality improvement initiatives
- Strong relationship-building skills with the ability to establish credibility and trust with physicians, clinic leadership, and office staff
- Excellent verbal, written, presentation, and interpersonal communication skills
- Strong problem-solving, conflict resolution, and customer service skills
- Ability to collaborate effectively across multiple departments in a matrixed healthcare environment
- Ability to analyze provider performance data and identify operational improvement opportunities
- Strong organizational skills with the ability to manage multiple priorities and competing deadlines
- Proficiency with Microsoft Office applications, including Excel, PowerPoint, and reporting tools
- Ability to maintain confidentiality and exercise sound judgment in sensitive situations
- Minimum of five (5) years of experience in Provider Relations, Provider Network Operations, Managed Care, Practice Management, Healthcare Operations, or a related healthcare environment
- Experience working with physicians, provider organizations, or medical practices required
- Bachelor's degree in Healthcare Administration, Business Administration, Public Health, Nursing, or a related field required
- Must have ability to travel
- Travel will be required to engage with potential providers, develop relationships with physicians, clinical teams, etc. and overall building of the organization's networks
- Candidates will follow our hybrid schedule, working in office three days per week
Desired Qualifications
- Experience supporting Medicare Advantage, delegated healthcare models, Accountable Care Organizations (ACOs), or value-based care initiatives preferred
- Previous leadership or supervisory experience preferred
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