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Provider Network Jobs in California (NOW HIRING)

WelbeHealth

Provider Network Management Associate

Carson, CA · On-site

$82.07K - $108.34K/yr

The Provider Network Management Associate is a critical field-based role accountable for the end-to-end lifecycle of the provider relationship. This includes building a strategic pipeline, advocating ...

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Provider Network information

What is a Provider Network job?

A Provider Network job involves managing relationships between healthcare providers and insurance companies or healthcare organizations. Responsibilities typically include contracting, credentialing, and ensuring network adequacy to meet patient needs. Professionals in this role negotiate provider agreements, analyze network performance, and ensure compliance with regulations. They play a key role in maintaining access to quality healthcare services for members.

What are the key skills and qualifications needed to thrive in the Provider Network position, and why are they important?

To thrive as a Provider Network professional, you need a solid understanding of healthcare operations, provider credentialing, and contract negotiation, typically supported by a bachelor’s degree in healthcare administration or a related field. Familiarity with provider databases, network management systems, and regulatory compliance platforms such as CAQH is often required. Strong relationship-building, problem-solving, and organizational skills set top candidates apart. These abilities are crucial for effectively developing, maintaining, and optimizing provider relationships within health plans or managed care organizations.

What are the typical daily responsibilities of a Provider Network professional?

A Provider Network professional typically spends their days building and maintaining relationships with healthcare providers, negotiating and renewing contracts, ensuring network adequacy, and responding to provider inquiries or concerns. The role often involves analyzing data on network performance, collaborating with internal teams such as claims, compliance, and credentialing, and conducting outreach to recruit new providers or expand network coverage. You may also monitor regulatory changes and support provider onboarding efforts. This role requires frequent communication, both internally and externally, to ensure quality care delivery and a seamless provider experience.
More about Provider Network jobs
What are the most commonly searched types of Provider Network jobs in California? The most popular types of Provider Network jobs in California are:
What are popular job titles related to Provider Network jobs in California? For Provider Network jobs in California, the most frequently searched job titles are:
What job categories do people searching Provider Network jobs in California look for? The top searched job categories for Provider Network jobs in California are:
What cities in California are hiring for Provider Network jobs? Cities in California with the most Provider Network job openings:
Provider Network jobs near you

Provider Network Manager

Community Health Plan of Imperial Valley

Imperial, CA • On-site

$85K - $115K/yr

Full-time

Medical, Retirement, PTO

Posted 23 days ago

Job description

About Us
Community Health Plan of Imperial Valley (CHPIV) is Imperial County's Medi-Cal managed care plan. We are a locally managed public health care plan committed to working with members, providers, and the residents of Imperial County.
Position Overview
Our team is growing, and we're looking for a Provider Network Manager to manage the strategic development and operations of CHPIV's directly contracted Medicare and Medi-Cal provider network. You will be responsible for developing, managing and servicing a network of individually contracted providers and Independent Physician Associations, including network adequacy, provider recruitment and contracting, performance monitoring, and maintaining strong relationships with providers to facilitate high-quality patient care.
Key Responsibilities
  • Provider Network Development: Identify gaps in the network, recruit new providers, and expand access to primary care, specialists, ancillary providers and facilities
  • Contract Negotiation: Negotiate favorable contract terms, reimbursement rates, service level agreements, and amendments for traditional and non-traditional providers
  • Provider Relationship Management: Maintain strong relationships with Independent Physician Associations (IPAs), hospitals, and other contracted providers, handling inquiries, escalations, and performance issues. Prepare agenda and lead quarterly joint operating committee meetings with IPAs, hospitals, and primary care providers, as needed.
  • Network Adequacy & Performance Improvement: Analyze provider performance, network coverage, and regulatory compliance. Educate and manage provider and IPA performance on STARS measures and risk adjustment coding documentation.
  • Onboarding & Training: Facilitate provider enrollment, credentialing, orientation, and ongoing education to ensure compliance with plan policies
  • Regulatory Compliance: Ensure adherence to healthcare regulations and program requirements, including CMS, Medicaid/Medicare standards,
  • Cross Collaboration: Work with outsourced vendors and internal subject matter experts to monitor and improve processes related to claims processing, utilization management, finance, and data file exchange.
  • Reporting & Analysis: Prepare performance reports, analyze network data, and provide strategic recommendations to leadership and other stakeholders.

Qualifications
  • Education: Bachelor's degree in healthcare administration, Business Administration, Public Health, or a related field. Master's preferred.
  • Experience: 5-8 years in provider relations, network management, or managed care; experience with Medicare/MAPD, Medicaid, or integrated delivery systems preferred.

What We Offer
  • Competitive salary of $85,000-$115,000/ year
  • Comprehensive benefits package that pays 85% of the cost of your family's healthcare
  • A 401 (k) with a generous match
  • Paid time off and holidays
  • Opportunities for growth and professional development
  • A chance to make a real difference in the health of your community

Apply