Director - Provider Relations
About The Position
We are seeking a highly motivated Director, Provider Relations to support our Provider Relations team at Astrana Health. This senior leadership role is responsible for developing and executing provider engagement, practice transformation, provider performance improvement, and value-based care strategies across assigned markets. The Director serves as the strategic liaison between Astrana Health and contracted provider partners and is accountable for driving improvements in quality performance, risk adjustment, utilization management, provider satisfaction, operational effectiveness, and financial outcomes. This role partners closely with Quality, Risk Adjustment, Operations, Network Development, Contracting, Claims, Clinical Operations, and executive leadership to ensure providers succeed within value-based care arrangements. The ideal candidate is a strategic healthcare leader with deep expertise in provider operations, managed care, population health, and value-based care who is passionate about improving outcomes for patients, providers, and the healthcare system.
Requirements
- Bachelor's degree in Healthcare Administration, Business Administration, Nursing, Public Health, Finance, or a related field
- Minimum of 8 years of healthcare leadership experience in Provider Relations, Managed Care, Value-Based Care, Population Health, IPA Operations, ACO Operations, or Network Performance
- Minimum of 5 years of progressive leadership experience managing provider-facing teams
- Demonstrated success leading provider performance improvement initiatives
- Experience working with Medicare Advantage, Medicaid, Commercial, and Value-Based Care programs
- Experience managing complex provider networks, delegated arrangements, and strategic provider partnerships
- Strong understanding of physician practice operations, managed care, and value-based care delivery models
- Expertise in practice transformation, provider engagement, population health management, and performance improvement strategies
- Strong knowledge of HEDIS, CMS Star Ratings, risk adjustment, RAF methodology, utilization management, and medical cost management
- Experience developing provider scorecards, performance improvement plans, and corrective action strategies
- Advanced proficiency in Microsoft Excel and PowerPoint
- Strong analytical, presentation, communication, facilitation, and negotiation skills
- Ability to translate complex clinical, operational, and financial data into actionable provider strategies
- Knowledge of applicable federal, state, CMS, and contractual requirements governing provider networks and healthcare programs
Nice To Haves
- Master's degree in Healthcare Administration, Business Administration, Public Health, Nursing, or a related field
- Experience with ACO REACH, MSSP, Medicare Advantage, Medicaid, Commercial, and other risk-bearing or value-based arrangements
- Experience with clinical documentation improvement and EHR optimization initiatives
- Experience supporting new market, payer, product, or provider-network implementations
- Professional certification such as CPHQ, CPC, CCS, PMP, Lean Six Sigma, or a similar healthcare or project management credential
Responsibilities
- Develop and execute provider engagement and performance improvement strategies aligned with organizational and market goals
- Lead provider-facing initiatives focused on quality improvement, risk adjustment, utilization management, value-based care performance, and financial sustainability
- Partner with provider organizations to drive practice transformation, workflow optimization, care coordination, and population health management initiatives
- Monitor provider performance against key metrics and develop action plans to improve quality outcomes, coding accuracy, documentation, utilization, and cost of care
- Serve as a strategic advisor and executive sponsor for key provider organizations and partnerships
- Collaborate with internal teams to address provider operational issues related to claims, authorizations, credentialing, rosters, directory accuracy, and delegated services
- Support network development, provider retention, network optimization, and market expansion initiatives
- Lead provider education efforts related to HEDIS, CMS Star Ratings, risk adjustment, value-based care programs, and regulatory requirements
- Analyze provider, clinical, operational, utilization, and financial performance data to identify trends and improvement opportunities
- Develop executive-level reporting and present provider performance updates, recommendations, and strategic initiatives to leadership and stakeholders
- Lead, mentor, and develop Provider Relations Managers and market-based provider engagement teams
- Foster a culture of accountability, collaboration, continuous improvement, and performance excellence
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What This Job Offers
Job Type
Full-time
Career Level
Senior
