Director, Provider Network

InnovAge Holding Corp.; Sacramento (CA); On-site; USD 120,000 - 180,000; Full time

Job summary

InnovAge seeks a Director, Provider Network in Sacramento to lead the development and sustainability of the community affiliate provider network for InnovAge PACE participants. You will contract with providers, educate networks, and ensure access to care in collaboration with clinical and operations teams.

Responsibilities include identifying provider targets, managing large contracts, and developing growth strategies to expand market presence while ensuring regulatory compliance with CMS and

Qualifications

• Bachelor’s degree in Business, Healthcare Administration, Public Health or related field.
• Minimum 8 years of experience in provider network development and management.
• Experience with complex contracting and provider relations.
• Experience with managed care contracting, Medicare and Medicaid preferred.

Responsibilities

• Identify provider targets and finalize contracts through InnovAge contracting process.
• Build relationships with providers to ensure partnerships meet participant needs.
• Educate providers on InnovAge PACE model, processes, and compliant materials.
• Coordinate with Legal, Compliance, Finance, Claims, Credentialing, and Provider Data Management.

Skills

Provider network management

Contract negotiations

Relationship building

Data analysis

Regulatory awareness

Education

Bachelor’s degree in Business/Healthcare Administration/Public Health

Tools

Microsoft Word

Excel

Outlook

Job description

Under the direction of theVice President, Provider Growth and Network Strategy, this role manages the development and sustainability of the community affiliate health provider network. Responsible for sourcing and the introduction of InnovAge PACE to the provider community. Works in collaboration with primary care, center operations, and operations leadership to identify and contract with community affiliate providers to meet the complex needs of the InnovAge PACE participants. This position will collaborate with InnovAge internal teams - Legal (contract documents), Compliance, Finance, Claims, Credentialing, and Provider Data Management - to coordinate related activities. The Director, Provider Network is responsible for contracting, provider education, and provider relations support of all community affiliate health providers to include inpatient and outpatient clinical and support services and interventional supports. In addition, the Director, Provider Network is the central external facing resource who provides provider and operational support to community affiliate health providers to ensure compliance with contracted terms, access, and availability.

Essential Functions and Work Responsibilities

Functional Category: Provider Network Management

Estimated Percent of time Spent – 100%

• Responsible for identifying provider targets initiating/finalizing provider contracts through the InnovAge contracting process.
• Supports the Network team as the subject matter expert when applicable for large health systems and multi-specialty group practices and organizations.
• Build and develop strong face to face and virtual relationships within the provider community to ensure that effective partnerships are in place to meet the needs of the organization and its participants.
• Works in collaboration with the Primary Care Team, Center Operations, and the Interdisciplinary Teams to identify gaps in the provider network.
• Responsible for conducting provider in-services and educating network providers on the InnovAge PACE model of care and processes.
• Responsible for utilizing InnovAge PACE approved materials that are in compliance with state, CMS and any other regulatory agency.
• Responsible for communicating and updating providers on any changes in practice or process in collaboration with the Interdisciplinary Team and the department VP.
• Conducts face to face provider service visits.
• Provide the department VP with their strategy approach to close access to care gaps through analysis of the provider network’s effectiveness and accessibility.
• Under the direction of the VP Provider Growth and Network Strategy assist in addressing provider related issues including but not limited to provider and participant grievance and appeals, claims payment disputes, delegated credentialing intake tool submissions, recredentialing CVO requests for affiliate community providers, communication barriers, and any other related provider relation concerns in a timely and a professional manner.
• Develop and lead provider network growth strategies that help strengthen our market presence and support enrollment growth across centers.
• Build and grow relationships with physicians, specialists, hospitals, health systems, and community referral sources to drive participant acquisition and retention.
• Identify and pursue new provider partnership opportunities in both current and emerging markets, ensuring expansion efforts support overall growth goals.
• Increase PACE awareness among providers through training, regular outreach, and use of existing provider and participant-facing materials.
• Work closely with Growth, Operations, Clinical, and Market Leadership teams to maximize provider relationships that drive referrals, improve access to care, and support census growth.
• Track provider network performance, referral trends, and market opportunities, and develop targeted plans to increase engagement and referral volume.

Travel Requirements

Travel

• Travel required
• Overnight travel out of state

Relocation

• Must be open to relocation based on business necessity

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

REQUIRED

Education

• Bachelor’s degree from an accredited college or university in an appropriate discipline; e.g., Business, Healthcare Administration, Public Health

Work Experience and Qualifications

• A minimum of 8 years’ experience with network development and management.
• Complex contracting and provider relations experience is required.
• Experience directing provider network contracting, process and service is essential.
• Experience with managed care contracting and provider relations
• Previous experience with Medicare and Medicaid is preferred

Other Knowledge Skills and Abilities Required

Computer Skills

• Must be computer proficient and possess experience with Microsoft Word, Excel, and Outlook and other Office products.
• Must be able to quickly learn specific software and new applications.

Mathematical/Financial Skills

• Ability to apply concepts such as fractions, percentages, ratios, and proportions to practical situations.
• Able to analyze data and statistics and draw reasonable conclusions and compile accurate reports.
• Experience with P/L and developing and managing medical cost initiatives.

Language Skills

• Ability to read, analyze and interpret regulations and other documents.
• Strong interpersonal skills and ability to effectively and tactfully present information to, and communicate with, co-workers, employees, and others.
• Possess exceptional English written and verbal communication skills, including accurate grammar and business correspondence knowledge.
• Ability to read and write memos, reports, and correspondence that conform to prescribed style and format.

Reasoning Ability

• Ability to define problems, collects data, establish facts, and draw valid conclusions.
• Intense intellectual curiosity and ability to view old problems with a fresh perspective

Other Skills and Abilities:

• Exceptional critical thinking ability to effectively adapt to