Job Title:
Provider Network Specialist
Reports To:
SVP, Network Operations
FLSA Status:
Exempt
Department:
Network Operations & Contracting
Job Summary
The Provider Network Specialist is responsible for growing and servicing Altus ACE’s primary care provider network across Medicare, Medicare Advantage, Medicaid, and commercial value-based care contracts. This is a dual-role position requiring both business development (recruiting and closing new PCPs) and account management (servicing existing provider groups to ensure satisfaction, retention, and performance against contract SLAs).
The ideal candidate combines a working knowledge of managed care and value-based care with strong sales instincts, relationship management skills, and the ability to interpret performance data and communicate actionable insights to providers.
Essential Functions
1. Network Growth & PCP Recruitment
- Prospect, recruit, and close new primary care physicians to join Altus ACE’s provider network and assigned PODs.
- Build and maintain a pipeline of prospective PCPs with managed care experience who are positioned to capitalize on their attributed patient populations through value-based care arrangements.
- Guide prospective providers through the full contracting process, from initial outreach to executed agreement.
- Collaborate with senior leadership to identify strategic growth targets by geography, payor mix, and contract need.
- Track recruitment activity and conversion metrics, reporting progress against growth targets.
- Lead contract negotiations with physicians.
- Assist with provider credentialing by ensuring all necessary documents are completed promptly and accurately.
2. Account Management & Provider Servicing
- Serve as the primary point of contact for assigned provider groups, owning the ongoing relationship and ensuring provider satisfaction and retention.
- Conduct regular site visits to provider locations, responding promptly to operational issues and proactively identifying needs.
- Orient newly contracted providers to Altus ACE programs, systems, and processes, ensuring a smooth onboarding experience.
- Provide training and support to providers and their staff on managed care topics, VBC program requirements, and ACE workflows.
- Develop educational materials to support provider understanding and facilitate behavior change aligned with population health goals.
- Act as a liaison between healthcare providers and the Altus ACE Network team, fostering strong professional relationships.
3. POD Operations & JOC Meeting Management
- Own the end-to-end Joint Operating Committee (JOC) meeting process for assigned PODs: pull performance data, assemble the meeting packet, set and drive the agenda, facilitate the meeting, and follow up on action items.
- Monitor POD performance metrics against payor contract SLAs, including shared savings, medical loss ratio, quality measures, and HCC recapture rates.
- Present performance data to providers during JOC meetings and site visits, translating data into clear, actionable improvement opportunities.
- Track PCP satisfaction within PODs and implement improvements as needed.
4. Clinical Operations & Population Health Support
- Identify opportunities with local providers to support clinical and quality-related operations.
- Contribute to the organization’s overall population health management strategy by reinforcing care gap closure and quality improvement at the practice level.
- Respond to routine member and provider inquiries regarding managed care issues, providing accurate and helpful information.
- Perform other related tasks as assigned, contributing to the success and efficiency of the Altus ACE network.
Qualifications
Required
- Bachelor’s degree in healthcare administration, business, or related field, or equivalent combination of transferable work experience and education.
- 2+ years of experience in provider relations, network development, healthcare sales, or managed care operations.
- Demonstrated understanding of managed care fundamentals: contracting, credentialing, provider networks, and payor relationships.
- Working knowledge of value-based care concepts, including shared savings, risk arrangements, medical loss ratio, and quality/performance metrics.
- Proven ability to close: track record of recruiting providers, closing contracts, or driving sales in a healthcare or professional services environment.
- Excellent communication and presentation skills with both internal and external audiences, including the ability to present data-driven performance insights to physicians.
- Strong relationship-building, problem-solving, and organizational skills.
- High proficiency with MS Office (Word, Excel, PowerPoint, Outlook), with particular strength in Excel for data analysis and reporting.
Preferred
- Experience working in an MSO, IPA, ACO, or similar value-based care organization.
- Experience preparing and presenting dashboards using data visualization tools such as Tableau or Power BI.
- Familiarity with Medicare, Medicare Advantage, and Medicaid programs and their associated quality measures (HEDIS, Stars, HCC coding).
Pay: $70,000.00 - $85,000.00 per year
Benefits:
- 401(k)
- 401(k) matching
- Dental insurance
- Employee assistance program
- Employee discount
- Flexible spending account
- Health insurance
- Health savings account
- Paid time off
- Vision insurance
Education:
Experience:
- Provider Relations: 2 years (Required)
- Preparing/Presenting dashboards w/Tableau or Power BI: 1 year (Preferred)
Ability to Commute:
- Houston, TX 77042 (Required)
Work Location: In person
