Provider Network Development Specialist at Hollywood Presbyterian

Los Angeles, California, United States -

Full Time

Start Date

Immediate

Expiry Date

21 Apr, 26

Salary

0.0

Posted On

21 Jan, 26

Experience

5 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Provider Contracting, Network Development, Health Plan Operations, Negotiation Skills, Relationship Building, Analytical Abilities, Communication Skills, Organizational Skills, Microsoft Office, Network Management Systems, Market Assessments, Utilization Analysis, Cost Trends, Provider Performance, Regulatory Compliance, Credentialing

Industry

Hospitals and Health Care

Description

Position Summary: The Provider Network Development Specialist is responsible for identifying, contracting, and managing relationships with healthcare providers—including Skilled Nursing Facilities, DME suppliers, home health agencies, ambulance providers, and specialty service vendors. This role supports network adequacy, cost management, and service accessibility across all product lines, ensuring contracted providers meet quality, compliance, and operational performance standards. Key Responsibilities Network Development & Contracting * Research, identify, and recruit new providers to support network growth and adequacy requirements. * Negotiate contract terms, rates, and service agreements with providers. * Prepare, review, and execute provider agreements, amendments, and renewals. * Maintain an understanding of reimbursement methodologies (FFS, case rates, bundled payments, capitation). Provider Relationship Management * Serve as a primary point of contact for downstream contracted providers. * Provide education on plan requirements and operational processes. * Support resolution of provider issues related to claims, credentialing, and authorizations. * Monitor provider performance metrics and compliance obligations. Network Analysis & Strategy * Conduct market assessments to identify network gaps. * Analyze utilization, cost trends, and provider performance. * Support strategic initiatives to improve network quality and value. * Collaborate with internal teams on pricing models and cost-of-care strategies. Operational Support * Ensure contracts comply with regulatory requirements. * Coordinate with credentialing and data management to support onboarding. * Maintain contract tracking and network status reports. * Support readiness activities for new markets and audits JOB QUALIFICATIONS Minimum Education (Indicate minimum education or degree required.) * Bachelor’s degree Preferred Education (Indicate preferred education or degree required.) * Masters in Health Administration or Masters in Business Administration Minimum Work Experience and Qualifications (Indicate minimum years of job experience, skills or abilities required for the job.) * 5 years of experience in provider contracting, network development, or health plan operations. * Understanding of downstream provider services and reimbursement structures. * Strong negotiation and relationship-building skills. * Analytical abilities to interpret utilization and cost data. * Excellent communication and organizational skills. * Proficiency with Microsoft Office and network management systems. Preferred Work Experience and Qualifications (Indicate preferred years of job experience, skills or abilities required for the job.) * Experience working with specialty vendors/providers preferred. Required Licensure, Certification, Registration or Designation (List any licensure or certification required and specify name of agency.) * Current Los Angeles County Fire Card (or must be obtained within 30 days of hire) * Assault Response Competency (ARC) required (within 30 days of hire) Full-Time, Exempt

Responsibilities

The Provider Network Development Specialist is responsible for identifying, contracting, and managing relationships with healthcare providers to support network adequacy and cost management. This role involves negotiating contracts, monitoring provider performance, and conducting market assessments to improve network quality.