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Remote Provider Network Management Jobs in California

Oscar Health

Product Manager, Network

San Francisco, CA · Remote

$135K - $178K/yr

... our provider network nationwide. You will collaborate with business and tech teams to build ... You will report into a Product Management leader. Work Location: This is a remote position, open to ...

Meta

Partner Manager, Network Investments

Menlo Park, CA · On-site +1

$162K/yr

This position is full time and based in our Menlo Park office [remote possible]. Partner Manager ... Meta is committed to providing reasonable accommodations for candidates with disabilities in our ...

Meta

Network Development Manager

Menlo Park, CA · On-site +1

$106K/yr

... management roles) * Experience managing vendor or provider relationships in a telecommunications or infrastructure context * Experience with fiber optic network concepts including route design, IRU ...

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Remote Provider Network Management information

What are the key skills and qualifications needed to thrive as a remote provider network management professional?

To thrive in Remote Provider Network Management, you need expertise in healthcare provider relations, contract negotiation, and a solid understanding of health plan regulations, often supported by a degree in healthcare administration or a related field. Familiarity with provider network management software, data analytics tools, and knowledge of regulations like HIPAA are typically required. Excellent communication, problem-solving abilities, and attention to detail are essential soft skills for building strong partnerships and managing network performance. These skills and qualifications ensure efficient network operations, regulatory compliance, and high-quality service for both providers and members.

What is the difference between Remote Provider Network Management vs Remote Provider Relations Specialist?

AspectRemote Provider Network ManagementRemote Provider Relations Specialist
CredentialsHealthcare administration, network management certificationsCustomer service, healthcare communication certifications
Work EnvironmentHealthcare organizations, insurance companies, remote office settingsHealthcare providers, insurance companies, remote customer support
Industry UsageManaging provider networks, credentialing, contractingBuilding provider relationships, resolving provider issues

Remote Provider Network Management focuses on overseeing healthcare provider networks, including credentialing and contracting. In contrast, Remote Provider Relations Specialists primarily handle communication and relationship-building with providers. Both roles require healthcare knowledge but differ in their core responsibilities and focus areas.

How does a remote provider network management professional typically collaborate with healthcare providers and internal teams?

Remote Provider Network Management professionals frequently coordinate with healthcare providers via virtual meetings, emails, and secure online portals to address contract negotiations, credentialing, and performance issues. They also work closely with internal departments such as claims, quality assurance, and customer service to ensure seamless provider onboarding and ongoing support. Effective communication and strong relationship-building skills are essential, as much of the collaboration happens through digital channels. This setup allows for flexibility but requires self-motivation and proactive engagement to maintain strong provider networks.

What is remote provider network management?

A Remote Provider Network Management role involves overseeing relationships and contracts with healthcare providers, such as doctors, hospitals, and clinics, while working remotely. Professionals in this field are responsible for recruiting new providers, maintaining communication, ensuring compliance with regulations, and addressing network issues. They play a key part in expanding and maintaining a healthcare organization's provider network to ensure members have access to quality care. This job typically requires strong organizational, negotiation, and communication skills, as well as familiarity with healthcare regulations and provider credentialing processes.

What are the most commonly searched types of Provider Network Management jobs in California?

The most popular types of Provider Network Management jobs in California are:

What are popular job titles related to Remote Provider Network Management jobs in California?

For Remote Provider Network Management jobs in California, the most frequently searched job titles are:

What job categories do people searching Remote Provider Network Management jobs in California look for?

The top searched job categories for Remote Provider Network Management jobs in California are:

What cities in California are hiring for Remote Provider Network Management jobs?

Cities in California with the most Remote Provider Network Management job openings:

Remote Provider Network Management jobs near you

Senior Provider Auditor - Claims

Scripps Health

San Diego, CA • Remote

Full-time

Posted 2 days ago

New

Scripps Health rating

8.6

Company rating: 8.6 out of 10

Based on 141 frontline employees who took The Breakroom Quiz

8th of 887 rated healthcare providers

Job description

This is a full-time, benefit eligible position that is remote and located in San Diego. Will be required to come into the office at minimum once a month or as needed.

Why join Scripps Health?

At Scripps Health, your ambition is empowered and your abilities are appreciated:

  • Nearly a quarter of our employees have been with Scripps Health for over 10 years.
  • Scripps is a Great Place to Work Certified company for 2025.
  • Scripps Health has been consistently ranked as a top employer for women, millennials, diversity, and as an overall workplace by various national publications.
  • Becker's Healthcare ranked Scripps Health on its 2026 list of 150 top places to work in health care.
  • We have transitional and professional development programs to create a learning environment that enables you to thrive in your specific field as well as in your overall career.
  • Our specialties have been nationally recognized for quality in areas such as cardiovascular care, oncology, orthopedics, geriatrics, obstetrics and gynecology, and gastroenterology.

Under general supervision, the Senior Provider Auditor utilizes key data to perform analysis and audits of managed care functions such as credentialing, claims, coding, provider information, timely access, or quality data. Maintains and performs ongoing monitoring of data, validation and identifies root cause analysis, risks and resolve data integrity issues. Prepares materials for committees and conducts face to face or remote provider education including the creation of the corrective action plan, training documents, and narrative to support and respond to regulatory deficiencies. Assembles evidence and documentation to investigate allegations of fraud, waste, and abuse.

Key responsibilities include:

  • Maintaining and updating Virtual Examiner (VE) coding edits to ensure alignment with industry standards, CPT, HCPCS, CMS, NCCI, and payer-specific coding requirements.
  • Working directly with the Information Systems (IS) Tapestry team and the VE vendor to develop, implement, and validate coding editor enhancements and updates.
  • Performing testing and validation of new coding rules and system changes prior to production implementation.
  • Managing coding editor escalations and resolving complex coding and reimbursement issues.
  • Serving as the subject matter expert for coding-related inquiries from Claims, Provider Operations, Configuration, Audit, Compliance, and Delegation Oversight teams.
  • Coordinating and validating semi-annual Medicare Fee Schedule (MFS) updates and related testing activities.
  • Supporting claims payment accuracy initiatives, audit readiness, and compliance requirements.

Required Education/Experience/Specialized Skills: 

  • Minimum of three (3) years' experience in healthcare/medical office environment.
  • Proficient with all Microsoft Office application.
  • Experience leading and facilitating work teams, with superior facilitation, interpersonal, verbal, and written communication skills.
  • Strong organizational and analytical skills; innovative with ability to identify, anticipate and solve problems.
  • Able to adapt, prioritize and meet deadlines.
  • Ability to present to key stake holders including physicians; ability to educate and train all levels of professional staff.

Required Certification/Registration: 

  • Required CCS-P, CCS, CDIP, CCDS, CHC, CIC, COC, CPC, CPMA, CPB, CRC, CDEO, Associate degree, or 5 years of related healthcare experience managing quality or data.

Preferred Education/Experience/Specialized Skills/Certification: 

  • Bachelor's degree and/or college coursework in a related field.
  • Knowledge of Epic Tapestry, Health Planet, and Timely Access Compliance and network filing.
  • Knowledge of claims processing regulations.
  • Experience with coding and HIPPA.
  • Strong knowledge of Excel.

What Scripps Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

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About Scripps Health

Sourced by ZipRecruiter

As a nationally recognized health system, Scripps Health is committed to providing the highest quality care to our patients. Through collaboration and innovation, our healthcare professionals lead the frontier in caring for our community. With a culture centered around teamwork, each laboratory site serves as a resource of support for each other, setting our laboratories as the benchmark for standardization.

Industry

Health care and social assistance

Company size

10,000+ Employees

Headquarters location

San Diego, CA, US

Year founded

1924

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