Location and Schedule: Huntington Beach, CA | Full-time | 100% onsite | Monday through Friday, 9:00 a.m. to 6:00 p.m.
Description: We are seeking an experienced Provider Network Manager (PNM) to build, maintain, and strengthen relationships with Independent Physician Associations (IPAs), hospitals, and other contracted provider groups.
The Provider Network Manager serves as the primary provider-facing contact, delivering high-quality service and support through effective communication, onboarding, issue resolution, and performance monitoring. This role executes network strategies, leads provider initiatives, and reports progress to leadership.
The Provider Network Manager also serves as a key liaison between provider partners and internal departments, promoting collaboration to meet regulatory, operational, and strategic objectives. This position is responsible for supporting network adequacy and maintaining a high level of provider satisfaction.
This position reports to the Senior Director of Provider Network.
What You Will Do: - Serve as the primary relationship manager for assigned IPAs and hospital systems.
- Conduct regular provider check-ins and monitor contract compliance and performance.
- Coordinate the onboarding of new IPAs and providers, including the timely distribution of materials, orientation sessions, and operational-readiness activities.
- Serve as an escalation point for provider inquiries and resolve issues in partnership with claims, utilization management, credentialing, and other internal departments.
- Receive, validate, and update IPA rosters, ensuring provider information is accurate, current, and submitted to Provider Data Management on time.
- Ensure roster-management processes meet CMS and other applicable compliance requirements.
- Organize and facilitate quarterly Joint Operations Committee meetings with IPAs and hospital systems.
- Build consensus around performance priorities and ensure follow-up actions are documented and completed.
- Collaborate with claims, utilization management, credentialing, compliance, member services, IT, and finance to enforce contract terms and regulatory requirements.
- Provide recommendations to improve operational workflows, provider support, and service delivery.
- Plan, coordinate, and host provider meetings, training sessions, educational programs, and appreciation events.
- Review monthly IPA network-adequacy reports and collaborate with leadership to develop action plans addressing access gaps.
- Communicate network performance to IPAs and coordinate the resolution of identified network gaps.
- Develop and maintain reporting frameworks to measure strategic initiatives, network performance, and progress.
- Partner with Provider Network Operations leadership to identify growth opportunities, retention strategies, and provider-outreach results.
- Manage provider additions and terminations in coordination with credentialing, contracting, and directory-maintenance teams.
- Facilitate the submission of provider credentialing applications and collaborate with the delegated Credentialing Verification Organization.
- Support adherence to NCQA and CMS credentialing standards.
- Distribute provider policy updates, newsletters, reminders, and other Provider Services communications.
- Participate in projects and initiatives that improve provider and member experiences.
- Perform other duties as assigned.
You Will Be Successful If: - You can build and maintain trusted relationships with IPAs, hospitals, and provider groups.
- You communicate effectively in writing and verbally with providers, leadership, and cross-functional teams.
- You are comfortable presenting to large groups and facilitating provider and committee meetings.
- You can identify problems, analyze root causes, and collaborate with others to implement timely resolutions.
- You can navigate cross-functional teams while balancing provider needs with organizational priorities.
- You demonstrate strong attention to detail in roster management, reporting, credentialing, and compliance-related processes.
- You can plan, coordinate, and execute multiple provider initiatives simultaneously.
- You are committed to delivering excellent service and improving the provider experience.
- You can use data and performance reporting to identify network gaps and recommend practical solutions.
- You can work independently while maintaining accountability and consistent communication with leadership.
What You Will Bring: - bachelor's degree in healthcare administration, business, or a related field, or equivalent professional experience.
- Three to five years of experience in provider relations, provider-network management, or healthcare operations.
- Experience working with a Medicare health plan, IPA, hospital system, or similar healthcare organization.
- Strong knowledge of managed-care concepts, provider contracting, Medicare Advantage Prescription Drug plans, and healthcare-delivery systems.
- Experience with provider rosters, credentialing, and regulatory compliance.
- Knowledge of CMS and NCQA requirements and standards.
- Proficiency with Microsoft Office Suite, including Excel, PowerPoint, and Word.
- The ability to analyze data, develop reports, and prepare professional presentations.
- Strong relationship-management, communication, problem-solving, organizational, project-management, and customer-service skills.
