Overall Purpose
The Senior Director, Provider Relations is responsible for the strategic leadership, development, and oversight of provider relationship management across P3 Health Partners markets. This role leads initiatives to strengthen provider engagement, optimize provider satisfaction and performance, and foster collaborative partnerships with physicians, hospitals, ancillary providers, and health system partners in support of organizational growth and value-based care initiatives.
The Senior Director serves as a strategic liaison between providers and internal operational, clinical, network, and executive leadership teams to ensure alignment with organizational objectives, regulatory requirements, quality initiatives, and financial performance. This leader is responsible for developing provider engagement strategies, resolving complex provider issues, supporting network performance, and driving continuous improvement in provider experience and operational effectiveness.
Essential Functions
- Provides strategic leadership for Provider Relations operations across assigned markets, ensuring alignment with organizational goals, value-based care initiatives, and enterprise growth strategies.
- Develops and executes enterprise-wide provider engagement and communication strategies that strengthen relationships with physicians, medical groups, hospitals, ancillary providers, and health system partners.
- Leads, develops, and mentors high-performing Provider Relations teams through recruitment, coaching, performance management, succession planning, and professional development.
- Serves as the executive point of contact for contracted providers regarding complex operational, reimbursement, payment, and contractual issues, ensuring timely resolution while maintaining strong provider relationships.
- Collaborates closely with Network Contracting, Medical Management, Clinical Operations, Quality, Finance, Claims Operations, and Executive Leadership to support provider performance, operational excellence, and organizational objectives.
- Partners with Network Contracting during provider negotiations, contract implementation, acquisitions, and network expansion initiatives to ensure successful provider onboarding, contract execution, and long-term provider engagement.
- Provides strategic oversight to ensure contracted providers are reimbursed in accordance with negotiated contract terms and reimbursement methodologies by partnering with Claims Operations, Network Contracting, and Finance to identify trends, resolve systemic issues, and improve provider satisfaction.
- Oversees provider payment escalations and reimbursement concerns, serving as the executive liaison between contracted providers and internal operational teams to facilitate timely and accurate issue resolution.
- Ensures delegated reimbursement policies, contractual obligations, and operational reimbursement processes are consistently implemented and adhered to across the organization while partnering with internal stakeholders to drive compliance and continuous improvement.
- Develops and monitors provider satisfaction metrics, identifies performance trends, and implements strategic action plans to improve provider experience, operational effectiveness, and provider retention.
- Leads provider education initiatives related to value-based care, quality programs, risk adjustment, STARS, HEDIS, clinical documentation improvement (CDI), reimbursement methodologies, operational workflows, and health plan requirements.
- Oversees the development of provider performance dashboards, scorecards, executive reporting, and strategic analyses to support organizational decision-making.
- Establishes and monitors key performance indicators (KPIs) related to provider satisfaction, provider engagement, provider reimbursement performance, issue resolution, operational effectiveness, and network performance.
- Identifies opportunities to improve provider access, network effectiveness, reimbursement processes, operational workflows, and cross-functional collaboration.
- Partners with executive leadership on strategic initiatives, acquisitions, market expansion, provider integration, and enterprise-wide provider engagement programs.
- Develops departmental goals, budgets, strategic initiatives, and performance metrics while monitoring operational and financial performance.
- Establishes enterprise-wide policies, governance, best practices, and standardized Provider Relations processes across all markets.
- Represents the organization in executive meetings with provider organizations, physician leadership, hospitals, health systems, accountable care organizations (ACOs), and health plan partners.
- Ensures compliance with applicable federal, state, CMS, delegated entity, contractual, and regulatory requirements impacting provider relationships and reimbursement activities.
- Promotes the mission, vision, and values of P3 Health Partners.
Knowledge, Skills and Abilities
- Extensive knowledge of provider relations, managed care operations, provider engagement strategies, value-based care, healthcare delivery systems, and delegated healthcare models.
- Strong understanding of provider reimbursement methodologies, claims adjudication processes, delegated reimbursement models, managed care contracting principles, Medicare Advantage, population health, risk adjustment, STARS, HEDIS, quality improvement programs, and healthcare operations.
- Demonstrated executive-level relationship management, negotiation, conflict resolution, and provider advocacy skills.
- Exceptional communication, presentation, and executive influence skills with the ability to build trusted relationships across all levels of the organization and with physicians, hospitals, health systems, ancillary providers, and health plans.
- Proven ability to develop and execute enterprise-wide strategic initiatives and successfully lead organizational change.
- Strong analytical, financial, and problem-solving skills utilizing provider performance, reimbursement, operational, and financial data.
- Experience developing executive dashboards, provider scorecards, strategic reporting, and performance analytics.
- Ability to establish performance metrics and drive continuous operational and process improvement.
- Strong organizational, leadership, coaching, mentoring, and talent development skills.
- Ability to manage multiple priorities within a complex, fast-paced, matrixed healthcare environment.
- Advanced proficiency with Microsoft Office applications, including Excel, PowerPoint, reporting tools, and business intelligence platforms.
Experience
- Minimum of 10 years of progressive leadership experience in provider relations, managed care, provider network operations, healthcare administration, or related healthcare leadership roles.
- Minimum of 5 years leading Provider Relations or Network Management teams.
- Demonstrated success building and maintaining executive-level relationships with physicians, hospitals, health systems, medical groups, ancillary providers, and health plans.
- Experience supporting value-based care models, provider performance improvement initiatives, and provider engagement strategies.
- Experience working with Medicare Advantage, managed care organizations, accountable care organizations (ACO), or delegated healthcare models strongly preferred.
Education
- Bachelors degree in Healthcare Administration, Business Administration, Public Health, or a related field required.
- Masters degree (MBA, MHA, MPH, or related field) strongly preferred.
Travel
Must have ability to travel. Travel will be required to engage with potential providers, develop relationships with physicians, clinical teams, etc. and overall building of the organization's networks.
Work Location & Schedule
This role offers a hybrid work arrangement. Candidates will follow our hybrid schedule, working in office three days per week.
Pay range: $175,000-200,000 depending on experience
About P3
People. Passion. Purpose.
At P3 Health Partners, our promise is to guide our communities to better health, unburden clinicians, align incentives and engage patients. We are a physician-led organization relentless in our mission to overcome all obstacles by positively disrupting the business of health care, transforming it from sickness care into wellness guidance. If you are passionate about your work; eager to have fun; and motivated to be part of a fast-growing organization, then you should consider joining our team.