Provider Relations – Market Performance Lead

Description

What You'll Do

• Provider Relationship & Performance Management 
  • Serve as the primary business and operational liaison for approximately 50–60 assigned primary care and specialty physician practices, representing the organization in matters requiring professional judgment. 
  • Establish and maintain strong, ongoing advisory relationships with physicians, clinicians, and practice staff through routine on-site and remote engagement.
  • Conduct regular provider visits to assess performance, identify barriers, and support improvement initiatives.
  • Document provider interactions, action plans, follow-ups, and outcomes to support continuous improvement and executive decision making
• Clinical Quality, Risk, and Performance Improvement 
  • Analyze, interpret, and present provider performance reports including HEDIS, risk adjustment, pay-for-performance, medical cost ratio (MCR), and other value-based performance metrics.
  • Provide subject-matter guidance and education to providers on clinical quality measures, documentation standards, risk adjustment, coding accuracy, and gap closure strategies. 
  • Coach providers on managing patients with multiple chronic conditions and appropriate inpatient utilization.
  • Identify trends, variances, and root causes of underperformance and develop targeted, data-driven improvement plans. 
• Practice Operations & Transformation 
  • Lead and influence workflow design and redesign initiatives, including EHR optimization, clinical documentation improvement, and care team workflow efficiency. 
  • Provide billing, claims, and encounter resolution support and partner with practices to improve submission accuracy and timeliness. 
  • Determine and implement corrective actions to address financial, operational, and quality performance gaps. 
  • Oversee provider onboarding, orientation, and ongoing education to ensure compliance with state, federal, and organizational standards, applying professional judgment in interpretation and execution. 
• Cross-Functional Collaboration 
  • Act as a key partner with internal teams including Quality Improvement, Risk Adjustment, Operations, and Provider Services to resolve provider issues and improve outcomes. 
  • Lead or contribute to cross-functional and regional initiatives impacting provider, market, and organizational performance. 
  • Communicate complex performance expectations and improvement strategies clearly to executive leadership, internal stakeholders, and physician groups. 
• Retention, Growth & Reporting 
  • Develop and drive improvement strategies for provider retention, engagement, and growth strategies within the assigned territory. 
  • Identify opportunities for operational improvement, market growth, and practice optimization. 
  • Maintain accurate and timely reporting of provider activity, performance trends, and improvement outcomes to inform leadership decisions. 
  • Perform other duties assigned by leadership in support of organizational objectives.

Qualifications

• Bachelor’s degree in Healthcare, Nursing, Public Health, Health Administration, Business, or a related field or equivalent combination of education and progressively responsible healthcare experience. 
• Master’s degree (MHA, MPH, or related) preferred.  
• 5–8 years of experience in provider relations, practice performance management, managed care operations, healthcare operations, quality improvement, risk adjustment, or related healthcare roles. 
• Demonstrated experience working directly with physician practices to improve quality, risk, and operational performance.
• Strong background in managed care and value-based care environments. 
• Experience with billing, claims, encounters, and practice workflow improvement strongly preferred. 
• License/Certifications (if applicable): • Clinical or coding credentials such as RN, LVN, LPN, CPC, or CCS preferred but not required. 
• Professional certifications such as CPHQ, MHA, MPH, PMP, or Lean/Six Sigma preferred. 
• Strong understanding of provider practice operations, managed care, and value-based care models. 
• Knowledge of clinical quality measures including HEDIS, risk adjustment, and performance-based reimbursement. 
• Ability to analyze complex performance data and translate findings into actionable improvement strategies. 
• High credibility in clinical and operational conversations with physicians and practice leadership. 
• Excellent written, verbal, and presentation communication skills. 
• Strong relationship-building, coaching, and problem-solving abilities. 
• Proficiency with Microsoft Office (Excel, Word, PowerPoint, Outlook). 
• Experience with EHRs, practice management systems, and provider performance dashboards. 

Environmental Job Requirements and Working Conditions

• This is a field-based role requiring frequent travel (up to 80–90%) within the assigned territory to provider practices and offices. Work is performed in physician offices, clinical settings, and professional office environments. 
• The role combines in-person practice engagement with remote work and requires reliable transportation, the ability to sit, stand, walk, and use standard office and computer equipment.
• The national target pay range for this role is: $80,000 - $90,000. Actual compensation will be determined based on geographic location (current or future), experience, and other job-related factors.