Director - Provider Relations

Astrana Health Management; Houston, Northern (TX, KY); Híbrido; USD 85.000 - 130.000; Jornada completa

Descripción de la vacante

Astrana Health Management is seeking a Director, Provider Relations to lead a dynamic team and drive engagement, performance improvement, and value-based care strategies across markets. This senior role partners with cross-functional teams to improve quality, risk adjustment, and financial outcomes.

The position requires deep expertise in provider operations, managed care, and population health, with a focus on collaboration, strategic advisory, and market expansion. Travel may be required.

Formación

• Bachelor's degree in Healthcare Administration, Business Administration, Nursing, Public Health, Finance, or a related field.
• 8+ years of healthcare leadership experience in Provider Relations, Managed Care, Value-Based Care, Population Health, IPA Operations, ACO Operations, or Network Performance.
• 5+ years of progressive leadership experience managing provider-facing teams.
• Demonstrated success leading provider performance improvement initiatives.
• Experience working with Medicare Advantage, Medicaid, Commercial, and Value-Based Care programs.
• Experience managing complex provider networks, delegated arrangements, and strategic provider partnerships.
• Strong understanding of physician practice operations, managed care, and value-based care delivery models.
• Expertise in practice transformation, provider engagement, population health management, and performance improvement strategies.
• Strong knowledge of HEDIS, CMS Star Ratings, risk adjustment, RAF methodology, utilization management, and medical cost management.
• Experience developing provider scorecards, performance improvement plans, and corrective action strategies.
• Advanced proficiency in Microsoft Excel and PowerPoint
• Strong analytical, presentation, communication, facilitation, and negotiation skills
• Ability to translate complex clinical, operational, and financial data into actionable provider strategies
• Knowledge of applicable federal, state, CMS, and contractual requirements governing provider networks and healthcare programs

Responsabilidades

• Develop and execute provider engagement and performance improvement strategies aligned with organizational and market goals.
• Lead provider-facing initiatives focused on quality improvement, risk adjustment, utilization management, value-based care performance, and financial sustainability.
• Partner with provider organizations to drive practice transformation, workflow optimization, care coordination, and population health management initiatives.
• Monitor provider performance against key metrics and develop action plans to improve quality outcomes, coding accuracy, documentation, utilization, and cost of care.
• Serve as a strategic advisor and executive sponsor for key provider organizations and partnerships.
• Collaborate with internal teams to address provider operational issues related to claims, authorizations, credentialing, rosters, directory accuracy, and delegated services.
• Support network development, provider retention, network optimization, and market expansion initiatives.
• Lead provider education efforts related to HEDIS, CMS Star Ratings, risk adjustment, value-based care programs, and regulatory requirements.
• Analyze provider, clinical, operational, utilization, and financial performance data to identify trends and improvement opportunities.
• Develop executive-level reporting and present provider performance updates, recommendations, and strategic initiatives to leadership and stakeholders.
• Lead, mentor, and develop Provider Relations Managers and market-based provider engagement teams.
• Foster a culture of accountability, collaboration, continuous improvement, and performance excellence

Conocimientos

Provider Leadership

Value-Based Care

Population Health

HEDIS Expertise

RAF Methodology

Excel

Data Analytics

Contracting Skills

Educación

Bachelor's degree (Healthcare Administration/related)

Master's degree (Healthcare Administration/related)

Descripción del empleo

Department: Care Enablement Operations

Employment Type: Full Time

Location: 19500 HWY 249, Suite 570 Houston, TX 77070

Reporting To: Karen Holt

Compensation: $85,000 - $130,000 / year

Description

About the Role

We are seeking a highly motivated Director, Provider Relations to support our Provider Relations team at Astrana Health. This senior leadership role is responsible for developing and executing provider engagement, practice transformation, provider performance improvement, and value-based care strategies across assigned markets.

The Director serves as the strategic liaison between Astrana Health and contracted provider partners and is accountable for driving improvements in quality performance, risk adjustment, utilization management, provider satisfaction, operational effectiveness, and financial outcomes. This role partners closely with Quality, Risk Adjustment, Operations, Network Development, Contracting, Claims, Clinical Operations, and executive leadership to ensure providers succeed within value-based care arrangements.

The ideal candidate is a strategic healthcare leader with deep expertise in provider operations, managed care, population health, and value-based care who is passionate about improving outcomes for patients, providers, and the healthcare system.

Our Values

• Put Patients First
• Empower Entrepreneurial Provider and Care Teams
• Operate with Integrity & Excellence
• Be Innovative
• Work As One Team

What You'll Do

• Develop and execute provider engagement and performance improvement strategies aligned with organizational and market goals
• Lead provider-facing initiatives focused on quality improvement, risk adjustment, utilization management, value-based care performance, and financial sustainability
• Partner with provider organizations to drive practice transformation, workflow optimization, care coordination, and population health management initiatives
• Monitor provider performance against key metrics and develop action plans to improve quality outcomes, coding accuracy, documentation, utilization, and cost of care
• Serve as a strategic advisor and executive sponsor for key provider organizations and partnerships
• Collaborate with internal teams to address provider operational issues related to claims, authorizations, credentialing, rosters, directory accuracy, and delegated services
• Support network development, provider retention, network optimization, and market expansion initiatives
• Lead provider education efforts related to HEDIS, CMS Star Ratings, risk adjustment, value-based care programs, and regulatory requirements
• Analyze provider, clinical, operational, utilization, and financial performance data to identify trends and improvement opportunities
• Develop executive-level reporting and present provider performance updates, recommendations, and strategic initiatives to leadership and stakeholders
• Lead, mentor, and develop Provider Relations Managers and market-based provider engagement teams
• Foster a culture of accountability, collaboration, continuous improvement, and performance excellence

Qualifications

• Bachelor's degree in Healthcare Administration, Business Administration, Nursing, Public Health, Finance, or a related field
• Minimum of 8 years of healthcare leadership experience in Provider Relations, Managed Care, Value-Based Care, Population Health, IPA Operations, ACO Operations, or Network Performance
• Minimum of 5 years of progressive leadership experience managing provider-facing teams
• Demonstrated success leading provider performance improvement initiatives
• Experience working with Medicare Advantage, Medicaid, Commercial, and Value-Based Care programs
• Experience managing complex provider networks, delegated arrangements, and strategic provider partnerships
• Strong understanding of physician practice operations, managed care, and value-based care delivery models
• Expertise in practice transformation, provider engagement, population health management, and performance improvement strategies
• Strong knowledge of HEDIS, CMS Star Ratings, risk adjustment, RAF methodology, utilization management, and medical cost management
• Experience developing provider scorecards, performance improvement plans, and corrective action strategies
• Advanced proficiency in Microsoft Excel and PowerPoint
• Strong analytical, presentation, communication, facilitation, and negotiation skills
• Ability to translate complex clinical, operational, and financial data into actionable provider strategies
• Knowledge of applicable federal, state, CMS, and contractual requirements governing provider networks and healthcare programs

Preferred Qualifications

• Master's degree in Healthcare Administration, Business Administration, Public Health, Nursing, or a related field
• Experience with ACO REACH, MSSP, Medicare Advantage, Medicaid, Commercial, and other risk-bearing or value-based arrangements
• Experience with clinical documentation improvement and EHR optimization initiatives
• Experience supporting new market, payer, product, or provider-network implementations
• Professional certification such as CPHQ, CPC, CCS, PMP, Lean Six Sigma, or a similar healthcare or project management credential

Environmental Job Requirements and Working Conditions

• Full-time leadership position supporting provider networks and value-based care initiatives across assigned markets
• Frequent use of a computer, telephone, and standard office equipment
• Ability to work in a fast-paced environment while managing multiple priorities and strategic initiatives
• Regular collaboration with providers, executive leadership, health plans, and cross-functional teams
• Travel may be required to support provider engagement, market operations, and business needs