Provider Network Manager (San Fernando)
About The Position
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.
Requirements
- Bachelor’s degree in Healthcare Administration, Business, Public Health, or a related field
- 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
Nice To Haves
- 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
- Advanced degree (MBA, MHA, MPH) a plus
Responsibilities
- 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
- 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
- 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
- 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
- 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
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What This Job Offers
Job Type
Full-time
Career Level
Manager
Number of Employees
501-1,000 employees
