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Provider Network Management Jobs (NOW HIRING)

Sonrava Health

Provider Network Manager

Sacramento, CA · Remote

$80K - $85K/yr

... network management throughout Northern California. This full-time, remote position is an excellent opportunity for a motivated professional who enjoys building strong provider relationships ...

Sonrava Health

Provider Network Manager

Sacramento, CA · Remote

$80K - $85K/yr

... network management throughout Northern California. This full-time, remote position is an excellent opportunity for a motivated professional who enjoys building strong provider relationships ...

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$22K

$106.6K

$162.5K

How much do provider network management jobs pay per year?

As of Aug 10, 2026, the average yearly pay for provider network management in the United States is $106,570.00, according to ZipRecruiter salary data. Most workers in this role earn between $80,500.00 and $128,000.00 per year, depending on experience, location, and employer.

What is provider network management?

A Provider Network Management job involves building, maintaining, and optimizing a healthcare provider network. Professionals in this role negotiate contracts, ensure provider compliance with regulations, and manage relationships with healthcare providers to maintain quality care and cost efficiency. They also analyze network performance, address gaps in coverage, and facilitate collaboration between insurers and providers. The goal is to ensure patients have access to high-quality care while keeping costs sustainable for healthcare organizations.

What does a provider network management do?

A provider network management professional oversees the relationships between healthcare providers and insurance companies, ensuring that providers meet contractual and quality standards. They coordinate provider enrollment, monitor network performance, and resolve issues to maintain a reliable network for members.

What are the key skills and qualifications needed to thrive in provider network management?

To excel in Provider Network Management, candidates typically need expertise in healthcare administration, contract negotiation, analytics, and a degree in a related field such as health services administration or business. Familiarity with network management platforms, claims processing systems, provider directories, and knowledge of regulations like HIPAA are highly valuable, as are certifications such as CPC or CPHQ. Strong relationship-building, problem-solving, and communication skills set top performers apart in facilitating partnerships between providers and healthcare payers. These abilities are essential to maintain robust provider networks, ensure compliance, and deliver quality healthcare services efficiently.

What are the typical daily responsibilities in provider network management?

In a Provider Network Management role, your day might include negotiating and administering contracts with healthcare providers, analyzing network performance metrics, and resolving provider issues or escalations. You’ll often collaborate with cross-functional teams such as claims, credentialing, and member services to ensure seamless network operations. Building and maintaining strong relationships with providers to address their needs, review compliance, and monitor service quality is a core part of the job. This position typically involves a mix of desk work, meetings, and occasional travel to visit provider offices or attend industry events.

More about Provider Network Management jobs
What cities are hiring for Provider Network Management jobs? Cities with the most Provider Network Management job openings:
What are the most commonly searched types of Provider Network Management jobs? The most popular types of Provider Network Management jobs are:
What states have the most Provider Network Management jobs? States with the most job openings for Provider Network Management jobs include:
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Provider Network Management jobs near you
Infographic showing various Provider Network Management job openings in the United States as of August 2026, with employment types broken down into 100% Full Time. Highlights an 92% In-person, and 8% Remote job distribution, with an average salary of $106,570 per year, or $51.2 per hour.

Director Provider Network Management

AmeriHealth Caritas Health Plan

Manchester, NH • On-site

Full-time

Posted 11 days ago

AmeriHealth Caritas rating

8.3

Company rating: 8.3 out of 10

Based on 73 frontline employees who took The Breakroom Quiz

127th of 304 rated insurance

Job description

Role Overview: The Director, Provider Network Management, is responsible for developing and executing the provider network strategy across all AmeriHealth Caritas New Hampshire lines of business. Reporting directly to the Market President and serving as a key member of the Executive Leadership Team, this leader will drive provider network performance, affordability, quality outcomes, population health initiatives, and provider satisfaction while strengthening AmeriHealth Caritas' position as the preferred healthcare partner throughout New Hampshire.
Work Arrangements:
  • Hybrid - Associate must be located in New Hampshire and work onsite at the Manchester, NH office three days per week.

Responsibilities:
  • Drive market provider network development and network management strategies to support business growth, network adequacy, and member access across all lines of business.
  • Develop and execute the annual provider network strategy, ensuring compliance with network adequacy requirements and establishing a competitive, marketable provider network.
  • Lead initiatives to improve provider satisfaction while ensuring compliance with pricing guidelines established by AmeriHealth Caritas Health Plan (AHC) and Plan leadership.
  • Monitor Single Case Agreement (SCA) trends and implement contracting strategies to reduce out-of-network utilization and improve network efficiency.
  • Provide leadership, coaching, performance management, and staffing oversight for the Provider Network Management team, including hiring, annual evaluations, and development planning.
  • Ensure departmental compliance with all federal and state regulations, accreditation standards, policies, and procedures; develop and revise departmental policies as needed.
  • Partner closely with the Market Director of Quality to advance key quality initiatives and performance measures, including Healthcare Effectiveness Data and Information Set (HEDIS), Consumer Assessment of Healthcare Providers and Systems (CAHPS), and National Committee for Quality Assurance (NCQA)/Utilization Review Accreditation Commission (URAC) standards.
  • Review provider satisfaction survey results and lead the development and implementation of action plans to address opportunities for improvement and enhance the provider experience.
  • Maintain accountability for the timely resolution of provider disputes, escalations, and contract-related concerns.
  • Oversee provider network performance and access, ensuring adequate geographic coverage and appropriate availability of services throughout the health plan's service area.
  • Bring strong operational knowledge related to provider satisfaction, provider education, and provider communications, with expertise in claims, payment integrity, provider data management, credentialing, appeals, and dispute resolution processes.
  • Provide oversight for large-scale provider terminations and network disruption mitigation strategies.
  • Ensure provider contracts align with approved reimbursement and claims payment methodologies.
  • Manage non-standard contract provisions, ensuring appropriate tracking, communication, and required approvals from AHC and Plan leadership before provider submission.
  • Lead complex negotiations with hospitals, health systems, physician groups, ancillary providers, and clinically integrated networks, including Value-Based Care (VBC) agreements and alternative payment models.
  • Provide strategic oversight of all facility, physician, ancillary, and physician extender network development and management activities.
  • Serve as the lead negotiator for high-impact provider agreements and Value-Based Care (VBC) arrangements as needed.
  • Perform other duties and strategic initiatives as assigned.

Education & Experience:
  • Bachelor's degree in business or health-related disciplines, such as healthcare administration or healthcare management, and equivalent business experience is preferred.
  • 3 years of experience in managed care provider contracting and reimbursement is required, including in-depth knowledge of reimbursement methodologies and contracting terms.
  • 1 to 2 years of Medicaid experience is preferred.
  • 8 to 10 years of progressive business management and negotiation experience is preferred.
  • 5 years of management experience, managing teams, and project management is preferred.
  • Demonstrated success across Medicaid, Medicare Advantage, D-SNP, and/or Exchange products.
  • Strong financial, analytical, negotiation, and executive communication skills.
  • Proven experience leading complex organizational and provider transformation initiatives.

Licensure:
  • Valid driver's license and current car insurance are required.

Skills & Abilities:
  • Strong financial acumen with experience analyzing provider economics, reimbursement methodologies, health plan performance, and business impact.
  • Advanced analytical capabilities with experience leveraging provider performance data, predictive analytics, business intelligence tools, and market intelligence to drive strategic decision-making.
  • Outstanding negotiation and influencing skills with a proven track record leading complex facility, physician, and value-based contracting negotiations.
  • Ability to develop and implement large-scale organizational change, provider transformation initiatives, and operating model enhancements.
  • Strong understanding of provider operations, claims administration, payment integrity, credentialing, provider data management, appeals, grievances, and dispute resolution processes.
  • Experience developing provider engagement, provider satisfaction, and provider communication strategies that improve provider experience and operational effectiveness.
  • Excellent verbal, written, presentation, and executive communication skills with the ability to effectively engage boards, executive leadership, providers, and government stakeholders.
  • Demonstrated ability to lead cross-functional teams, influence without direct authority, and build consensus across complex organizational environments.
  • Strategic thinker with the ability to anticipate market trends, identify growth opportunities, and align provider strategy with organizational goals.
  • Ability to balance quality outcomes, affordability, member experience, and provider satisfaction while driving measurable business results.
  • Strong project management and organizational skills with the ability to manage multiple priorities in a fast-paced, highly regulated environment.
  • Proficiency with healthcare analytics platforms, provider performance reporting tools, Microsoft Office Suite, and other healthcare technology solutions.
  • Commitment to fostering a culture of accountability, collaboration, innovation, continuous improvement, and member-centered care.

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