Senior Provider Network Manager

Jobtailor; Cerritos (CA); On-site; USD 120,000 - 180,000; Full time

Job summary

Jobtailor seeks a seasoned Contracting and Provider Relations professional to lead and optimize a regional provider network in California. You will negotiate complex contracts, customize fee schedules, and mentor staff while collaborating with sales and enterprise teams.

You will work with large institutional providers, medical groups, and ancillary providers, ensuring effective network coverage and actuarial-fee modeling underpins decisions.

Qualifications

• BA/BS degree required.
• Minimum 5 years' contracting or provider relations experience.
• Prior contracting experience required.
• Equivalent combination of education and experience may be accepted.
• Experience in fee schedule development using actuarial models strongly preferred.
• Willingness to travel to worksites and other locations as necessary.
• Ability to commute to posting location within a reasonable distance.
• In-office 3–4 days per week.
• COVID-19 and Influenza vaccination may be required unless an exemption is provided.

Responsibilities

• Develop the provider network through contract negotiations, relationship development, and servicing.
• Focus on contracting and negotiating contract terms with complex providers.
• Work with large institutional providers, large medical groups, ancillary providers, and value-based concepts.
• Negotiate non-standard arrangements requiring advanced negotiation skills.
• Customize fee schedules.
• Serve as a key resource for contracting staff.
• Provide mentoring and on-the-job training and development.
• Work independently using judgment and discretion.
• Collaborate on business-unit and enterprise network-management projects.
• Collaborate with sales teams on presentations to employer groups.
• Serve as a communication link between professional providers and the company.
• Ensure appropriate distribution of provider specialties in the network.
• Conduct complex negotiations and draft documents.
• Prepare financial projections and conduct analysis.

Skills

Contracting

Negotiation Skills

Relationship Development

Judgment and Discretion

Collaboration

Communication

Actuarial Models

Fee Schedule Development

Financial Analysis

Provider Relations

Fee Schedule Customization

Contract Negotiation

Provider Network

Education

BA/BS Degree

Job description

• Develop the provider network through contract negotiations, relationship development, and servicing


• Focus on contracting and negotiating contract terms with complex providers


• Work with large institutional providers, large medical groups, ancillary providers, and value-based concepts


• Negotiate non-standard arrangements requiring advanced negotiation skills


• Customize fee schedules


• Serve as a key resource for contracting staff


• Provide mentoring and on-the-job training and development


• Work independently using judgment and discretion


• Collaborate on business-unit and enterprise network-management projects


• Collaborate with sales teams on presentations to employer groups


• Serve as a communication link between professional providers and the company


• Ensure appropriate distribution of provider specialties in the network


• Conduct complex negotiations and draft documents


• Prepare financial projections and conduct analysis

Requirements

• BA/BS degree


• Minimum of 5 years' experience in contracting, provider relations, or provider servicing


• Prior contracting experience


• Equivalent combination of education and experience may be accepted


• Experience in fee schedule development using actuarial models strongly preferred


• Ability to travel to worksite and other locations as necessary


• Ability to work within a reasonable commuting distance from the posting location(s)


• Candidates must work in-office 3-4 days per week


• Certain patient/member-facing roles require COVID-19 and Influenza vaccination unless an acceptable explanation is provided

Core Competencies

Demonstrates expertise in contract negotiations and provider relations, with a strong focus on customizing fee schedules and conducting complex negotiations. Proven ability to mentor and train staff while collaborating effectively with sales teams and managing provider networks.

Highest-signal resume keywords

• Contract Negotiation


• Provider Relations


• Fee Schedule Development


• Financial Projections


• Mentoring and Training

Hard Skills

• Contracting


• Negotiation Skills


• Fee Schedule Customization


• Financial Analysis


• Actuarial Models

Soft Skills

• Relationship Development


• Judgment and Discretion


• Collaboration


• Communication

Certifications & Qualifications

• BA/BS Degree

Industry Keywords

• Provider Network


• Value-Based Concepts


• Institutional Providers


• Medical Groups


• Ancillary Providers