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Astrana Health

Technology-enabled platform delivering value-based care

Director Provider Relations

Business OperationsUpdated on Nov 13
Full-timeHouston, TX, USA$85k - $145k /yr

About the Job

Requirements

  • A Bachelor's degree in Healthcare Administration, Business Administration, Nursing, Public Health, Finance, or a related field is required.
  • At least 8 years of healthcare leadership experience in Provider Relations, Managed Care, Value-Based Care, Population Health, IPA Operations, ACO Operations, or Network Performance is required.
  • At least 5 years of progressive leadership experience managing provider-facing teams is required.
  • Demonstrated success leading provider performance improvement initiatives is required.
  • Experience with Medicare Advantage, Medicaid, Commercial, and Value-Based Care programs is required.
  • Experience managing complex provider networks, delegated arrangements, and strategic provider partnerships is required.
  • A strong understanding of physician practice operations, managed care, and value-based care delivery models is required.
  • Expertise in practice transformation, provider engagement, population health management, and performance improvement strategies is required.
  • Strong knowledge of HEDIS, CMS Star Ratings, risk adjustment, RAF methodology, utilization management, and medical cost management is required.
  • Experience developing provider scorecards, performance improvement plans, and corrective action strategies is required.
  • Advanced proficiency in Microsoft Excel and PowerPoint is required.
  • Strong analytical, presentation, communication, facilitation, and negotiation skills are required.
  • The ability to translate complex clinical, operational, and financial data into actionable provider strategies is required.
  • Knowledge of applicable federal, state, CMS, and contractual requirements governing provider networks and healthcare programs is required.

Responsibilities

  • Develop and execute provider engagement and performance improvement strategies aligned with organizational and market goals.
  • Lead provider-facing initiatives focused on quality improvement, risk adjustment, utilization management, value-based care performance, and financial sustainability.
  • Partner with provider organizations to drive practice transformation, workflow optimization, care coordination, and population health management initiatives.
  • Monitor provider performance against key metrics and develop action plans to improve quality outcomes, coding accuracy, documentation, utilization, and cost of care.
  • Serve as a strategic advisor and executive sponsor for key provider organizations and partnerships.
  • Collaborate with internal teams to address provider operational issues related to claims, authorizations, credentialing, rosters, directory accuracy, and delegated services.
  • Support network development, provider retention, network optimization, and market expansion initiatives.
  • Lead provider education efforts related to HEDIS, CMS Star Ratings, risk adjustment, value-based care programs, and regulatory requirements.
  • Analyze provider, clinical, operational, utilization, and financial performance data to identify trends and improvement opportunities.
  • Develop executive-level reporting and present provider performance updates, recommendations, and strategic initiatives to leadership and stakeholders.
  • Lead, mentor, and develop Provider Relations Managers and market-based provider engagement teams.
  • Foster a culture of accountability, collaboration, continuous improvement, and performance excellence.

Desired Qualifications

  • A Master's degree in Healthcare Administration, Business Administration, Public Health, Nursing, or a related field is preferred.
  • Experience with ACO REACH, MSSP, Medicare Advantage, Medicaid, Commercial, and other risk-bearing or value-based arrangements is preferred.
  • Experience with clinical documentation improvement and EHR optimization initiatives is preferred.
  • Experience supporting new market, payer, product, or provider-network implementations is preferred.
  • A professional certification such as CPHQ, CPC, CCS, PMP, Lean Six Sigma, or a similar healthcare or project management credential is preferred.

About the Company

Astrana Health

Technology-enabled platform delivering value-based care

Astrana Health runs a physician-focused, technology-enabled care platform that supports providers in delivering proactive, preventive, value-based care. Its end-to-end system coordinates care across affiliated networks, a management services organization, and primary, specialty, and ancillary clinics to help more than 20,000 providers and over 1.6 million Americans in value-based arrangements. How it works: the proprietary platform connects clinicians, patients, and care settings, enabling proactive care planning, care coordination, and efficient delivery of services in primary and specialty care. The company differentiates itself by combining a large provider network, an MSO, and clinics with a single tech platform to scale value-based care and improve patient experiences and outcomes rather than relying on fragmented, fee-for-service models. Its goal is to create a healthcare system that delivers better care, better experiences, and better outcomes for all.

Company size
501-1,000
Company stage
Not listed
Total funding
Not listed
Headquarters
Alhambra, CA
Founded
Not listed

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