Healthcare Managed Care Consultant

The Provider Liaison serves as the primary liaison between healthcare providers and the organization, fostering strong partnerships that support operational excellence, quality outcomes, and strategic initiatives. This role is responsible for managing provider relationships, supporting network management and contracting efforts, and driving provider education regarding reimbursement models, regulatory requirements, and organizational programs. The position plays a critical role in improving provider satisfaction, operational efficiency, and the delivery of high-quality healthcare services.

• Serve as the primary relationship manager for assigned healthcare providers and provider groups.
• Develop, maintain, and strengthen relationships with physicians, practice administrators, hospitals, and other healthcare organizations.
• Educate providers on network strategies, reimbursement models, operational processes, and organizational initiatives.
• Identify provider concerns and operational challenges; recommend and coordinate effective solutions.
• Partner with internal departments including Operations, Medical Management, Network Management, Provider Contracting, Claims, and Customer Service to resolve provider issues.
• Act as the voice of the provider community by gathering feedback and communicating recommendations to internal leadership and project teams.
• Support provider contracting activities and implementation of strategic network initiatives.
• Analyze provider performance metrics, utilization reports, and operational data to identify improvement opportunities.
• Conduct provider meetings, educational sessions, and presentations regarding policy updates, reimbursement changes, compliance requirements, and new programs.
• Maintain visibility within the provider community through regular onsite visits, professional meetings, and industry events.
• Monitor healthcare industry trends, reimbursement methodologies, regulatory changes, and market developments.
• Assist with implementation of value-based care initiatives and other healthcare transformation programs.
• Maintain accurate documentation of provider interactions, issue resolution, and project activities.
• Participate in cross-functional projects designed to improve provider engagement, operational efficiencies, and member outcomes.

• Bachelor's degree in Business Administration, Healthcare Administration, Public Health, Finance, or a related field required.
• Equivalent combination of education and relevant provider relations or healthcare industry experience may be considered.
• Minimum of 3–5 years of experience in provider relations, healthcare administration, managed care, health insurance, or provider network management.
• Experience working directly with physician practices, hospitals, or healthcare organizations.
• Experience with provider contracting, reimbursement methodologies, or healthcare operations preferred.
• Experience managing multiple projects and priorities within a matrixed organization.

• Knowledge of healthcare reimbursement methodologies, provider contracting, and network management.
• Working knowledge of CMS regulations, Medicare Advantage, Medicaid, HIPAA, and other applicable healthcare regulations.
• Ability to travel throughout the regional service area for provider meetings and industry events.
• Valid driver's license may be required.
• Ability to deliver presentations to provider groups and executive leadership.

• Strong knowledge of healthcare delivery systems and provider operations.
• Understanding of managed care principles, provider contracting, and reimbursement models.
• Knowledge of value-based care initiatives and population health strategies.
• Strong financial and analytical skills with the ability to interpret provider performance data.
• Excellent negotiation and conflict resolution skills.
• Strong project management and organizational abilities.
• Outstanding written, verbal, and presentation skills.
• Ability to build and maintain productive relationships with physicians and healthcare executives.
• Strong problem-solving and process improvement capabilities.
• Profici…