Provider Relations – Market Performance Lead

Astrana Health

Job Location:

Houston, MS - USA

Yearly Salary: $ 80000 - 90000

Posted on: 6 hours ago

Vacancies: 1 Vacancy

Job Summary

We are currently seeking a highly motivated Provider Relations Market Performance Lead in the Houston area who will serves as a strategic field-based partner to physician practices supporting improvements in clinical quality risk adjustment operational efficiency and financial performance. This role works directly with primary care and specialty practices to analyze performance identify root causes of gaps and lead practice transformation efforts through provider education workflow redesign and data-driven interventions. While clinical licensure is not required the role demands a strong working knowledge of clinical workflows quality measures and managed care operations to effectively engage providers and drive sustainable improvement.

What Youll Do

Provider Relationship & Performance Management
- Serve as the primary business and operational liaison for approximately 5060 assigned primary care and specialty physician practices representing the organization in matters requiring professional judgment.
- Establish and maintain strong ongoing advisory relationships with physicians clinicians and practice staff through routine on-site and remote engagement.
- Conduct regular provider visits to assess performance identify barriers and support improvement initiatives.
- Document provider interactions action plans follow-ups and outcomes to support continuous improvement and executive decision making
Clinical Quality Risk and Performance Improvement
- Analyze interpret and present provider performance reports including HEDIS risk adjustment pay-for-performance medical cost ratio (MCR) and other value-based performance metrics.
- Provide subject-matter guidance and education to providers on clinical quality measures documentation standards risk adjustment coding accuracy and gap closure strategies.
- Coach providers on managing patients with multiple chronic conditions and appropriate inpatient utilization.
- Identify trends variances and root causes of underperformance and develop targeted data-driven improvement plans.
Practice Operations & Transformation
- Lead and influence workflow design and redesign initiatives including EHR optimization clinical documentation improvement and care team workflow efficiency.
- Provide billing claims and encounter resolution support and partner with practices to improve submission accuracy and timeliness.
- Determine and implement corrective actions to address financial operational and quality performance gaps.
- Oversee provider onboarding orientation and ongoing education to ensure compliance with state federal and organizational standards applying professional judgment in interpretation and execution.
Cross-Functional Collaboration
- Act as a key partner with internal teams including Quality Improvement Risk Adjustment Operations and Provider Services to resolve provider issues and improve outcomes.
- Lead or contribute to cross-functional and regional initiatives impacting provider market and organizational performance.
- Communicate complex performance expectations and improvement strategies clearly to executive leadership internal stakeholders and physician groups.
Retention Growth & Reporting
- Develop and drive improvement strategies for provider retention engagement and growth strategies within the assigned territory.
- Identify opportunities for operational improvement market growth and practice optimization.
- Maintain accurate and timely reporting of provider activity performance trends and improvement outcomes to inform leadership decisions.
- Perform other duties assigned by leadership in support of organizational objectives.

Qualifications

Bachelors degree in Healthcare Nursing Public Health Health Administration Business or a related field or equivalent combination of education and progressively responsible healthcare experience.
Masters degree (MHA MPH or related) preferred.
58 years of experience in provider relations practice performance management managed care operations healthcare operations quality improvement risk adjustment or related healthcare roles.
Demonstrated experience working directly with physician practices to improve quality risk and operational performance.
Strong background in managed care and value-based care environments.
Experience with billing claims encounters and practice workflow improvement strongly preferred.
License/Certifications (if applicable): Clinical or coding credentials such as RN LVN LPN CPC or CCS preferred but not required.
Professional certifications such as CPHQ MHA MPH PMP or Lean/Six Sigma preferred.
Strong understanding of provider practice operations managed care and value-based care models.
Knowledge of clinical quality measures including HEDIS risk adjustment and performance-based reimbursement.
Ability to analyze complex performance data and translate findings into actionable improvement strategies.
High credibility in clinical and operational conversations with physicians and practice leadership.
Excellent written verbal and presentation communication skills.
Strong relationship-building coaching and problem-solving abilities.
Proficiency with Microsoft Office (Excel Word PowerPoint Outlook).
Experience with EHRs practice management systems and provider performance dashboards.

Environmental Job Requirements and Working Conditions

This is a field-based role requiring frequent travel (up to 8090%) within the assigned territory to provider practices and offices. Work is performed in physician offices clinical settings and professional office environments.
The role combines in-person practice engagement with remote work and requires reliable transportation the ability to sit stand walk and use standard office and computer equipment.
The national target pay range for this role is: $80000 - $90000. 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 on 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 based on 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.

What Youll Do

Provider Relationship & Performance Management
- Serve as the primary business and operational liaison for approximately 5060 assigned primary care and specialty physician practices representing the organization in matters requiring professional judgment.
- Establish and maintain strong ongoing advisory relationships with physicians clinicians and practice staff through routine on-site and remote engagement.
- Conduct regular provider visits to assess performance identify barriers and support improvement initiatives.
- Document provider interactions action plans follow-ups and outcomes to support continuous improvement and executive decision making
Clinical Quality Risk and Performance Improvement
- Analyze interpret and present provider performance reports including HEDIS risk adjustment pay-for-performance medical cost ratio (MCR) and other value-based performance metrics.
- Provide subject-matter guidance and education to providers on clinical quality measures documentation standards risk adjustment coding accuracy and gap closure strategies.
- Coach providers on managing patients with multiple chronic conditions and appropriate inpatient utilization.
- Identify trends variances and root causes of underperformance and develop targeted data-driven improvement plans.
Practice Operations & Transformation
- Lead and influence workflow design and redesign initiatives including EHR optimization clinical documentation improvement and care team workflow efficiency.
- Provide billing claims and encounter resolution support and partner with practices to improve submission accuracy and timeliness.
- Determine and implement corrective actions to address financial operational and quality performance gaps.
- Oversee provider onboarding orientation and ongoing education to ensure compliance with state federal and organizational standards applying professional judgment in interpretation and execution.
Cross-Functional Collaboration
- Act as a key partner with internal teams including Quality Improvement Risk Adjustment Operations and Provider Services to resolve provider issues and improve outcomes.
- Lead or contribute to cross-functional and regional initiatives impacting provider market and organizational performance.
- Communicate complex performance expectations and improvement strategies clearly to executive leadership internal stakeholders and physician groups.
Retention Growth & Reporting
- Develop and drive improvement strategies for provider retention engagement and growth strategies within the assigned territory.
- Identify opportunities for operational improvement market growth and practice optimization.
- Maintain accurate and timely reporting of provider activity performance trends and improvement outcomes to inform leadership decisions.
- Perform other duties assigned by leadership in support of organizational objectives.

Qualifications

Bachelors degree in Healthcare Nursing Public Health Health Administration Business or a related field or equivalent combination of education and progressively responsible healthcare experience.
Masters degree (MHA MPH or related) preferred.
58 years of experience in provider relations practice performance management managed care operations healthcare operations quality improvement risk adjustment or related healthcare roles.
Demonstrated experience working directly with physician practices to improve quality risk and operational performance.
Strong background in managed care and value-based care environments.
Experience with billing claims encounters and practice workflow improvement strongly preferred.
License/Certifications (if applicable): Clinical or coding credentials such as RN LVN LPN CPC or CCS preferred but not required.
Professional certifications such as CPHQ MHA MPH PMP or Lean/Six Sigma preferred.
Strong understanding of provider practice operations managed care and value-based care models.
Knowledge of clinical quality measures including HEDIS risk adjustment and performance-based reimbursement.
Ability to analyze complex performance data and translate findings into actionable improvement strategies.
High credibility in clinical and operational conversations with physicians and practice leadership.
Excellent written verbal and presentation communication skills.
Strong relationship-building coaching and problem-solving abilities.
Proficiency with Microsoft Office (Excel Word PowerPoint Outlook).
Experience with EHRs practice management systems and provider performance dashboards.

Environmental Job Requirements and Working Conditions

This is a field-based role requiring frequent travel (up to 8090%) within the assigned territory to provider practices and offices. Work is performed in physician offices clinical settings and professional office environments.
The role combines in-person practice engagement with remote work and requires reliable transportation the ability to sit stand walk and use standard office and computer equipment.
The national target pay range for this role is: $80000 - $90000. Actual compensation will be determined based on geographic location (current or future) experience and other job-related factors.