Provider Network Manager (San Fernando)
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Job Location:
El Monte, CA - USA
Yearly Salary:
$ 78567 - 100828
Posted on:
10 days ago
Vacancies:
1 Vacancy
Job Summary
Job Title: Provider Network Manager
Department: Network Management
About the Role: The Provider Network Manager is responsible for managing and optimizing assigned segments of the provider network in San Fernando Valley 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.
Department: Network Management
About the Role: The Provider Network Manager is responsible for managing and optimizing assigned segments of the provider network in San Fernando Valley 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 Youll 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
- 5 years of experience in provider network management provider relations or managed care operations
- Experience working with physician networks IPAs hospitals or health plans
- Strong understanding of managed care delegated risk models and provider network operations Preferred 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
Youre great for the role if:
- Bachelors degree in Healthcare Administration Business Public Health or a related field. Advanced degree (MBA MHA MPH) a plus
Environmental Job Requirements and Working Conditions
- Our organization follows a hybrid work structure where the expectation is to work both in office and at home 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: $78566.91 - $100827.53. 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 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.
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.
Required Experience:
Manager
