Provider Relations & Network Strategy Consultant

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

Job summary

CareMore Health Management Services, LLC is seeking a Network Relations Consultant to own provider performance, conduct on-site visits, and resolve issues within a managed care network. The role emphasizes PAHAF completion, STAR rating improvement, and education of providers on policies and reimbursement practices.

The ideal candidate will have a Bachelor's degree, at least three years in customer service including network management, and be able to travel to various worksites as needed.

Qualifications

• Bachelor's degree required.
• Minimum 3 years of customer service experience including 2 years in network management.
• Willingness to travel to worksites as needed.
• Strong problem solving and communication skills.

Responsibilities

• Manage provider relationships with regular on-site visits.
• Identify and resolve provider issues and educate on policies.
• Coordinate contract-related activities for new and existing providers.
• Facilitate provider training and materials distribution.
• Monitor PAHAF, STARS gaps, and HCC capture.
• Lead communication on medical policy and reimbursement patterns.
• Support claims and referrals issue resolution.
• Assist in provider education and onboarding.

Skills

Customer service

Provider relations

On-site visits

Contract coordination

Education

Bachelor's degree

Job description

CareMore Health Management Services, LLC is seeking a Network Relations Consultant to own provider performance, conduct on-site visits, and resolve issues within a managed care network. The role emphasizes PAHAF completion, STAR rating improvement, and education of providers on policies and reimbursement practices.

The ideal candidate will have a Bachelor's degree, at least three years in customer service including network management, and be able to travel to various worksites as needed.