Serves as the primary liaison between the health plan and its network of healthcare providers. Builds and maintains strong relationships within the provider community to support quality care delivery. Oversees new provider orientation and delivers ongoing training to ensure understanding of the plan’s standards, policies, programs, and contractual obligations. Monitors network adequacy and takes appropriate action as needed. Collaborates with marketing, sales, and care center teams to ensure member needs are effectively met.

Overview

• Communicate proactively with both prospective and existing providers to meet evolving business needs.

• Guide providers through the full onboarding process, including application, credentialing, and contracting.

• Conduct in-person site visits with prospective providers, as required by plan standards.

• Lead new provider orientations and deliver ongoing training sessions to ensure continued compliance and engagement.

• Build and maintain strong, collaborative relationships with providers, office staff, and key stakeholders.

• Maintain an up-to-date directory of contacts across functional areas such as Managed Care, Credentialing, Claims, Contracting, Quality, and Population Health.

• Oversee a designated geographic territory, managing strategic provider partnerships and collaborating with internal family health centers and marketing staff.

• Serve as the primary liaison for providers, offering guidance on plan policies, directory accuracy, claims procedures, and other operational inquiries.

• Schedule and conduct regular office and facility visits with high-volume providers in alignment with departmental goals.

• Address and resolve provider inquiries related to credentialing, contract terms, reimbursement, claims, access standards, member eligibility, and reporting requirements.

• Accurately document and monitor provider issues, ensuring timely resolution in line with plan policies.

• Coordinate cross-departmental efforts to resolve complex provider concerns and identify trends for process improvement.

• Collaborate with marketing and sales teams on outreach initiatives aimed at expanding the provider network and increasing brand visibility.
  
  Earn between $70,000-$75,000 for this role! This is a direct hire opportunity. This position is hybrid.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients