Provider Network Relations Specialist

CareMore Health; Los Angeles (CA); On-site; USD 81,000 - 121,000; Full time

Job summary

CareMore Health seeks a Network Relations Consultant to drive provider performance, including PAHAF completion, AWV and Star ratings of 4 or above. The role involves on-site relationship development with MDs, coordinating contracts and education, and resolving issues to ensure high-quality service.

Responsibilities include regular provider visits, education delivery, issue resolution, and collaboration with claims, pricing, and medical management to optimize network performance.

Qualifications

• Requires a Bachelor’s degree.
• Minimum of 3 years of customer service experience including 2 years experience as a Network Management Rep.
• Willingness to travel to worksites and other locations as necessary.

Responsibilities

• Develops and maintains positive provider relationships through on-site visits and education.
• Resolves complex provider issues and coordinates contract-related matters.
• Coordinates communications on policies, reimbursement, and provider utilization patterns.
• Conducts provider training and distributes relations materials.
• Tracks provider utilization patterns and supports provider negotiations.

Skills

Customer service

Provider relations

Communication

Education

Bachelor's degree

Job description

CareMore Health seeks a Network Relations Consultant to drive provider performance, including PAHAF completion, AWV and Star ratings of 4 or above. The role involves on-site relationship development with MDs, coordinating contracts and education, and resolving issues to ensure high-quality service.

Responsibilities include regular provider visits, education delivery, issue resolution, and collaboration with claims, pricing, and medical management to optimize network performance.