Provider Network Development Specialist

Hollywood Presbyterian•Los Angeles, CA

10d

About The Position

The Provider Network Development Specialist is responsible for identifying, contracting, and managing relationships with healthcare providers—including Skilled Nursing Facilities, DME suppliers, home health agencies, ambulance providers, and specialty service vendors. This role supports network adequacy, cost management, and service accessibility across all product lines, ensuring contracted providers meet quality, compliance, and operational performance standards.

Requirements

Bachelor’s degree
5 years of experience in provider contracting, network development, or health plan operations.
Understanding of downstream provider services and reimbursement structures.
Strong negotiation and relationship-building skills.
Analytical abilities to interpret utilization and cost data.
Excellent communication and organizational skills.
Proficiency with Microsoft Office and network management systems.
Current Los Angeles County Fire Card (or must be obtained within 30 days of hire)
Assault Response Competency (ARC) required (within 30 days of hire)

Nice To Haves

Masters in Health Administration or Masters in Business Administration
Experience working with specialty vendors/providers preferred.

Responsibilities

Network Development & Contracting
Research, identify, and recruit new providers to support network growth and adequacy requirements.
Negotiate contract terms, rates, and service agreements with providers.
Prepare, review, and execute provider agreements, amendments, and renewals.
Maintain an understanding of reimbursement methodologies (FFS, case rates, bundled payments, capitation).
Provider Relationship Management
Serve as a primary point of contact for downstream contracted providers.
Provide education on plan requirements and operational processes.
Support resolution of provider issues related to claims, credentialing, and authorizations.
Monitor provider performance metrics and compliance obligations.
Network Analysis & Strategy
Conduct market assessments to identify network gaps.
Analyze utilization, cost trends, and provider performance.
Support strategic initiatives to improve network quality and value.
Collaborate with internal teams on pricing models and cost-of-care strategies.
Operational Support
Ensure contracts comply with regulatory requirements.
Coordinate with credentialing and data management to support onboarding.
Maintain contract tracking and network status reports.
Support readiness activities for new markets and audits