Provides daily support and coaching to program coordinators and partners. * Utilizes established software, tools, and resources needed for program execution and oversight. * Utilizes online ...
Provides daily support and coaching to program coordinators and partners. * Utilizes established software, tools, and resources needed for program execution and oversight. * Utilizes online ...
Provides daily support and coaching to program coordinators and partners. * Utilizes established software, tools, and resources needed for program execution and oversight. * Utilizes online ...
Provides daily support and coaching to program coordinators and partners. * Utilizes established software, tools, and resources needed for program execution and oversight. * Utilizes online ...
Provides daily support and coaching to program coordinators and partners. * Utilizes established software, tools, and resources needed for program execution and oversight. * Utilizes online ...
Provides daily support and coaching to program coordinators and partners. * Utilizes established software, tools, and resources needed for program execution and oversight. * Utilizes online ...
Program Manager II - Provider Network Management
Redding, CA · On-site
$96K - $121K/yr
Provides daily support and coaching to program coordinators and partners. * Utilizes established software, tools, and resources needed for program execution and oversight. * Utilizes online ...
Program Manager II - Provider Network Management
Redding, CA · On-site
$96K - $121K/yr
Provides daily support and coaching to program coordinators and partners. * Utilizes established software, tools, and resources needed for program execution and oversight. * Utilizes online ...
IT Specialist
Santa Clarita, CA · On-site
$66K - $80K/yr
About Heritage Provider Network: Heritage owns and operates one of the largest healthcare delivery systems nationally with over 5,000 employees. Heritage manages its provider network to offer ...
IT Specialist
Santa Clarita, CA · On-site
$66K - $80K/yr
About Heritage Provider Network: Heritage owns and operates one of the largest healthcare delivery systems nationally with over 5,000 employees. Heritage manages its provider network to offer ...
Network Representative
Richmond, CA · On-site
$20.25 - $25.75/hr
Do you inspire others with your kindness and joy? We're different than most primary care providers. We're rapidly expanding and we need great people to join our team. The ChenMed Network ...
Network Representative
Richmond, CA · On-site
$20.25 - $25.75/hr
Do you inspire others with your kindness and joy? We're different than most primary care providers. We're rapidly expanding and we need great people to join our team. The ChenMed Network ...
Provider Relations Representative (Remote in AZ - Pima or Pinal)
Pasadena, CA · On-site
$30 - $32/hr
Provider Network Administrator FLSA STATUS: Exempt DEPARTMENT: Provide Network Management REPORTS TO: Sr. Provider Network Administrator JOB SUMMARY: Maintains a successful working relationship ...
Quick apply
Provider Relations Representative (Remote in AZ - Pima or Pinal)
Pasadena, CA · On-site
$30 - $32/hr
Provider Network Administrator FLSA STATUS: Exempt DEPARTMENT: Provide Network Management REPORTS TO: Sr. Provider Network Administrator JOB SUMMARY: Maintains a successful working relationship ...
Provider Relations Representative (Remote in AZ - Pima or Pinal)
Pasadena, CA · On-site
$30 - $32/hr
Provider Network Administrator FLSA STATUS: Exempt DEPARTMENT: Provide Network Management REPORTS TO: Sr. Provider Network Administrator JOB SUMMARY: Maintains a successful working relationship ...
Quick apply
Provider Relations Representative (Remote in AZ - Pima or Pinal)
Pasadena, CA · On-site
$30 - $32/hr
Provider Network Administrator FLSA STATUS: Exempt DEPARTMENT: Provide Network Management REPORTS TO: Sr. Provider Network Administrator JOB SUMMARY: Maintains a successful working relationship ...
Contracted Network Specialist
Escondido, CA · On-site
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
Contracted Network Specialist
Escondido, CA · On-site
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
The successful candidate provides direction and oversight to all provider network development and maintenance as well as coordination and deployment of reimbursement operations. This position works ...
The successful candidate provides direction and oversight to all provider network development and maintenance as well as coordination and deployment of reimbursement operations. This position works ...
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
Quick apply
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
Contracted Network Specialist - PACE
Escondido, CA · On-site
$38.55 - $55.52/hr
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
Contracted Network Specialist - PACE
Escondido, CA · On-site
$38.55 - $55.52/hr
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
Quick apply
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
The Contracted Network Specialist - PACE supports the execution of PACE provider network strategy by managing day-to-day contracting, provider onboarding, credentialing coordination, and ongoing ...
Job Summary Provides executive strategy and leadership to team responsible for network operations and contracting activities. Supports network strategy and development with respect to adequacy ...
Job Summary Provides executive strategy and leadership to team responsible for network operations and contracting activities. Supports network strategy and development with respect to adequacy ...
Open enrollment events to provide information regarding physicians and services available through BFMG and/or CCPN and associated facilities. * Networking at public/social functions on behalf of BFMG ...
Open enrollment events to provide information regarding physicians and services available through BFMG and/or CCPN and associated facilities. * Networking at public/social functions on behalf of BFMG ...
Healthcare Network Manager
Los Angeles, CA · On-site
$25 - $30/hr
Provides service and education via onsite visits and telephone. Assists providers with ... Identifies network gaps and performs recruitment to address community network needs. * Build and ...
Quick apply
Healthcare Network Manager
Los Angeles, CA · On-site
$25 - $30/hr
Provides service and education via onsite visits and telephone. Assists providers with ... Identifies network gaps and performs recruitment to address community network needs. * Build and ...
Provider Activation Specialist
La Crescenta, CA · On-site
$65K - $85K/yr
Fosters and maintains proactive, positive relations throughout the provider network through face-to face visits, emails, telephone calls, etc. * Facilitates the onboarding process for new providers.
Quick apply
Provider Activation Specialist
La Crescenta, CA · On-site
$65K - $85K/yr
Fosters and maintains proactive, positive relations throughout the provider network through face-to face visits, emails, telephone calls, etc. * Facilitates the onboarding process for new providers.
Referral Coordinator (Templeton, CA)
Templeton, CA · On-site
$24.27 - $28.55/hr
... providers in regard to questions regarding network specialists. 1.4 Ability to prepare authorizations and refer to appropriate providers/facilities and durable medical equipment (DME) companies. 1.5 ...
Referral Coordinator (Templeton, CA)
Templeton, CA · On-site
$24.27 - $28.55/hr
... providers in regard to questions regarding network specialists. 1.4 Ability to prepare authorizations and refer to appropriate providers/facilities and durable medical equipment (DME) companies. 1.5 ...
Provider Network information
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.
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 is a provider network?
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.

Full-time
Re-posted 10 days ago
Job description
To develop, implement, improve, and manage assigned programs. In addition to the Program Manager I duties, the Program Manager II has a higher level of experience, more autonomy, exercises independent judgement, and conducts business analysis and program analytics. Programs are ongoing, which may include aligned projects and requires strategic planning and continuous improvement efforts after program startup. Participates in the design, implementation, and/or expansion of strategic programs and departmental initiatives. Develops and delivers program goals, measures, and reports.
Responsibilities- Manages the day to day duties of assigned program(s); including data entry, tracking, and reporting.
- Reviews program data accuracy, completeness, and required submissions.
- Guides program staff in successful implementation of program activities.
- Works with Supervisor to manage program budget(s).
- Monitors system level reports developed for programs. Summarizes observations and conclusions to make recommendations to leadership.
- Identifies and resolves program issues and concerns in a timely manner with minimal support and recommends solutions to leadership for final decision as necessary.
- Attends program meetings and follows-up with stakeholders on outstanding deliverables and action items.
- Plans, coordinates and facilitates events, conferences, and webinars, as needed.
- Develops and publishes agendas, meeting minutes, and necessary documentation.
- Facilitates and leads both internal and external meetings.
- Develops and publishes communication/updates to program stakeholders.
- Oversees the development of stakeholder reports on defined schedule.
- Communicates program outcomes and potential risks to all levels of leadership.
- Leads program evaluation and continuous improvement.
- Oversees the successful implementation of new and assigned programs and their associated processes.
- Develops and implements strategies to engage stakeholders.
- May supervise and provide guidance to staff as assigned.
- Provides daily support and coaching to program coordinators and partners.
- Utilizes established software, tools, and resources needed for program execution and oversight.
- Utilizes online collaboration applications.
- Leads user demos, trainings and setup as needed
- Maintains documentation per department specifications.
- Other duties as assigned.
Education and Experience
Bachelor's degree in Business Administration, Business Management, Computer Science or relevant field and at least two years of relevant program management experience required. In lieu of degree, a minimum of four (4) years of relevant experience to include a minimum of two (2) years program management experience will be considered.
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Special Skills, Licenses and Certifications
Strong communication skills, both verbal and written, to interpret and articulate program requirements to involved stakeholders. Exceptional interpersonal and customer service skills. Ability to establish and maintain effective working relationships across all levels within the organization. Detail-oriented. Strong organization skills with ability to prioritize assignments and manage time effectively. Strong decision making, problem solving, critical thinking skills. Able to work under pressure and meet critical deadlines in a fast-moving environment. Adaptable to a continuous changing environment. Working knowledge of project management methodologies required. Proficient experience in use of various computer system software including Windows, Microsoft Word, Excel, Outlook, Visio, and PowerPoint. Valid California driver's license and proof of current automobile insurance compliant with Partnership policy are required to operate a vehicle and travel for company business.
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Performance Based Competencies
Knowledge of business practices and protocols with ability to access data and information using automated systems. Ability to participate in team based projects. Strong organizational skills with ability to prioritize assignments and maintain effective filing systems and meet deadlines. Strong attention to detail; critical thinking/listening and communication skills.
Work Environment And Physical Demands
More than 50% of work time is spent using a computer. Ability to lift, carry, or move objects of varying size, weighting up to 25 lbs. Must be able to work in a fast-paced environment and maintain courtesy and composure when dealing with internal and external customers. Ability to function effectively with frequent interruptions and direction from multiple team members.
All HealthPlan employees are expected to:
- Provide the highest possible level of service to clients;
- Promote teamwork and cooperative effort among employees;
- Maintain safe practices; and
- Abide by the HealthPlan's policies and procedures, as they may from time to time be updated.
HIRING RANGE
$96,970.04Â - $121,212.56
IMPORTANT DISCLAIMER NOTICE
The job duties, elements, responsibilities, skills, functions, experience, educational factors and the requirements and conditions listed in this job description are representative only and not exhaustive or definitive of the tasks that an employee may be required to perform. The employer reserves the right to revise this job description at any time and to require employees to perform other tasks as circumstances or conditions of its business, competitive considerations, or work environment change.
Employment Type: FULL_TIMEAbout Partnership HealthPlan of California
Sourced by ZipRecruiter
Industry
Insurance services
Company size
501 - 1,000 Employees
Headquarters location
Fairfield, CA, US
Year founded
1994