PROVIDER NETWORK MANAGER - PACE

Job Purpose

The Provider Network Manager manages and strengthens the provider network for the Program of All-Inclusive Care for the Elderly (PACE). This role leads provider network operations, supports provider recruitment and onboarding, oversees ongoing provider engagement, and ensures network adequacy to meet regulatory and participant care requirements.

The position plays a central role in maintaining provider relationships, coordinating credentialing activities, supporting compliance, and ensuring providers understand and support the PACE care model.

Duties and Responsibilities

Provider Network Management

• Manage day-to-day operations of the PACE provider network.
• Support provider recruitment to address geographic and specialty gaps.
• Coordinate provider onboarding and engagement activities.
• Assess network capacity and identify access risks.
• Recommend network improvements to PACE leadership.

Provider Relationship Management

• Serve as a key liaison between PACE and contracted providers.
• Maintain ongoing relationships with provider offices and facilities.
• Conduct regular outreach to reinforce PACE workflows and expectations.
• Address provider concerns affecting participant access.
• Escalate unresolved issues with documentation.

Credentialing and Onboarding Oversight

• Oversee onboarding workflows with the Credentialing Coordinator.
• Track credentialing and re-credentialing timelines.
• Ensure documentation completeness and timeliness.
• Resolve onboarding or credentialing delays.

Network Operations and Reporting

• Maintain accurate provider records and directories.
• Support directory updates and distribution.
• Generate network reports for leadership.
• Monitor provider responsiveness and access trends.

Compliance and Quality Support

• Align network activities with CMS, DHCS, and PACE requirement.
• Support audits and regulatory reviews.
• Maintain documentation to demonstrate network adequacy.

Perform as additional duties as assigned.

Qualifications

• Bachelor’s degree in healthcare administration, business, public health, or related field required.
• Five or more years of experience in provider network management or healthcare operations.
• Experience with hospitals, specialists, and healthcare vendors.
• Experience supporting credentialing or network compliance.
• Experience with PACE, Medicare Advantage, or Medi-Cal managed care preferred.

Skills and Competencies

• Strong relationship management
• Independent operational judgment
• Strong organization and problem solving
• Knowledge of provider network operations

Physical Demands

• Must be able to remain in a stationary position 50% of the time.
• Ability to occasionally move about inside the office to access file cabinets, office machinery, etc.
• Able to operate a computer and other office productivity machinery, such as a calculator, copy machine, and computer printer.
• Able to constantly position yourself to maintain files in file cabinets such as reaching with hands and arms, kneeling, crouching, etc.
• The ability to communicate, detect, converse with, discern, convey, express oneself, and exchange information is crucial for this role.
• Ability to travel locally to provider offices and facilities.
• Ability to drive for provider engagement.

Direct Reports

Reports to Director of Operations - PACE