The Role
Manage and optimize assigned provider network segments to ensure access, panel capacity, and performance. Support provider performance and quality initiatives (HEDIS, STARS), partner with contracting/credentialing and operations, resolve provider escalations, ensure regulatory compliance (DMHC, CMS), support audits and delegated risk requirements, and provide cross-functional market and provider insights to inform network strategy.
Summary Generated by Built In
About the Role:
The Provider Network Manager is responsible for managing and optimizing assigned segments of the provider network to ensure adequate access, strong provider performance, and alignment with organizational quality, financial, and growth objectives. This role serves as a key operational and relationship manager for physicians, IPAs, hospitals, and ancillary providers and acts as a primary point of contact for network-related issues within the assigned market. This position does not have direct reports but plays a critical role in influencing outcomes through collaboration with internal partners and external provider organizations.
The Provider Network Manager is responsible for managing and optimizing assigned segments of the provider network to ensure adequate access, strong provider performance, and alignment with organizational quality, financial, and growth objectives. This role serves as a key operational and relationship manager for physicians, IPAs, hospitals, and ancillary providers and acts as a primary point of contact for network-related issues within the assigned market. This position does not have direct reports but plays a critical role in influencing outcomes through collaboration with internal partners and external provider organizations.
What You'll Do
Provider Network Management & Optimization
- Manage day-to-day performance and relationships for assigned providers, IPAs, hospitals, and specialty networks
- Monitor network adequacy, access standards, panel capacity, and geographic coverage to support membership growth and retention
- Identify network gaps, capacity constraints, and performance risks; recommend corrective actions to leadership
Provider Performance & Quality Support
- Support provider performance related to quality measures, utilization, and value-based care initiatives
- Collaborate with Quality, Medical Management, and Analytics teams to reinforce quality programs, incentive alignment, and performance improvement efforts
- Assist in driving improvement in key metrics such as HEDIS, STARS, utilization management, and member experience
Contract & Network Operations Support
- Partner with Contracting and Credentialing teams to support provider onboarding, terminations, network expansions, and contract implementation
- Ensure accurate provider data, network directories, and system configuration in collaboration with operations teams
- Support execution of provider incentive programs and contract-related initiatives
Provider Relations & Issue Resolution
- Serve as a primary escalation point for provider network issues, including access, operational challenges, and performance concerns
- Facilitate effective communication between providers and internal teams to resolve issues efficiently and maintain strong provider relationships
- Support preparation and participation in Joint Operating Committee (JOC) meetings and provider governance forums
Regulatory & Compliance Support
- Ensure network management activities comply with health plan requirements and state and federal regulations (e.g., DMHC, CMS)
- Support audits, regulatory submissions, and delegated risk requirements related to network operations
- Maintain documentation and reporting to support compliance and operational readiness
Cross-Functional Collaboration
- Partner closely with internal stakeholders including Medical Management, Quality, Claims, DSS/Analytics, Finance, Customer Service, and Government Programs
- Support implementation of network policies, workflows, and process improvements
- Provide market and provider insights to inform broader network strategy and leadership decision-making Performs other duties as assigned by the department leaders
- Other duties as assigned
Qualifications
- Bachelor’s degree in Healthcare Administration, Business, Public Health, or a related field
- At least 5 years of experience in provider network management, provider relations, or managed care operations
- Have experience working with physician networks, IPAs, hospitals, or health plans
- Strong understanding of managed care, delegated risk models, and provider network operations
You're great for the role if:
- Have experience working with delegated risk or value-based care models
- Experience in California managed care markets
- Familiarity with DMHC access standards, CMS requirements, and delegated risk oversight
- Advanced degree (MBA, MHA, MPH) a plus
Environmental Job Requirements and Working Conditions
- Our organization follows a regional/hybrid work structure where the expectation is to work both in office and visiting provider offices on a weekly basis. The office is located at 9700 Flair Drive, El Monte, CA 91731.
- The total compensation target pay range for this role is: $80,000 - $90,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.
Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action Employer. We do not discriminate based upon race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided on the basis of qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at [email protected] to request an accommodation.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
Additional Information:
The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change.
About
Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.
Skills Required
- Bachelor's degree in Healthcare Administration, Business, Public Health, or a related field
- At least 5 years of experience in provider network management, provider relations, or managed care operations
- Experience working with physician networks, IPAs, hospitals, or health plans
- Strong understanding of managed care, delegated risk models, and provider network operations
- Ability to work a regional/hybrid schedule and visit provider offices on a weekly basis (office: El Monte, CA)
- Experience working with delegated risk or value-based care models
- Experience in California managed care markets
- Familiarity with DMHC access standards, CMS requirements, and delegated risk oversight
- Advanced degree (MBA, MHA, MPH)
Am I A Good Fit?
Get Personalized Job Insights.
Our AI-powered fit analysis compares your resume with a job listing so you know if your skills & experience align.
Success! Refresh the page to see how your skills align with this role.
The Company
What We Do
Astrana Health is a physician-centric, technology-powered healthcare company that operates an integrated delivery platform. It enables providers to participate in value-based care arrangements, helping them deliver accessible, high-quality, and cost-effective care to patients. The company provides care coordination services to patients, primary care physicians, specialists, and health plans, leveraging proprietary technology to streamline operations and improve patient outcomes across local communities.
.png)
