Provider Relationship Manager - San Antonio
Harbor Health, San Antonio, TX, United States
Provider Relationship Manager - San Antonio
Regional Health Plan | Provider Relations | Network Operations
COMPANY OVERVIEW At Harbor Health, we’re transforming healthcare in Texas through collaboration and innovation. We’re seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you’re ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!
POSITION DUTIES & RESPONSIBILITIES The Provider Relationship Manager serves as the “boots on the ground” representative of the health plan for all in-network provider groups across the region. This role is responsible for ensuring an exceptional member experience by building strong provider relationships, resolving operational issues, improving network performance, and aligning provider groups with the health plan’s strategic objectives.
The Provider Relationship Manager acts as the primary point of contact for in-network practices and works cross-functionally with contracting, claims, credentialing, care management, and member services to proactively remove friction and drive measurable network performance improvements.
This is a highly visible, field-based role that blends provider relations, operational problem-solving, and performance management.
Key Responsibilities 1. Provider Relationship Management
Serve as the primary relationship owner for assigned in-network provider groups
Conduct regular in-person and virtual visits with practices.
Build trust-based partnerships with physicians, practice managers, and administrative leadership.
Represent the health plan in a professional, responsive, and solutions-oriented manner.
Key Responsibilities 2. Member Experience Optimization
Ensure providers understand plan benefits, referral pathways, authorization requirements, and network structure.
Identify and resolve issues that negatively impact member access, scheduling, billing, or care coordination.
Monitor complaints, grievances, and service trends tied to assigned groups.
Proactively intervene to prevent network friction before it impacts members.
Key Responsibilities 3. Operational Issue Resolution
Troubleshoot and resolve claims, eligibility, prior authorization, and billing concerns.
Partner with internal teams to elevate and close provider issues quickly.
Track and trend recurring operational problems and recommend system improvements.
Support clean claims performance and administrative simplification.
Key Responsibilities 4. Network Performance & Accountability
Review provider-level performance metrics (access, quality, cost, utilization).
Support implementation of value-based initiatives and performance programs.
Educate providers on quality measures, documentation, and coding best practices.
Assist with corrective action plans when needed.
Key Responsibilities 5. Network Growth & Retention
Support onboarding of newly contracted provider groups.
Ensure smooth implementation and readiness before go-live.
Monitor provider satisfaction and mitigate termination risk.
Provide field intelligence on competitive dynamics and provider market trends.
Key Responsibilities 6. Cross-Functional Collaboration
Partner with:
Network Contracting
Claims Operations
Care Management
Utilization Management
Member Services
Credentialing
Serve as the feedback loop between the provider community and internal leadership.
QUALIFICATIONS
5+ years experience in:
Provider relations
Network operations
Practice management
Health plan operations
Strong understanding of:
Claims processing
Authorizations
Credentialing
Network adequacy
Value-based reimbursement models
Experience working directly with physician groups and MSOs.
Excellent communication and conflict-resolution skills.
Highly organized with ability to manage multiple provider relationships simultaneously.
Willingness to travel regionally (50–70%).
Preferred:
Experience in regional or startup health plans.
Experience supporting CINs or value-based models.
Data literacy (Excel, reporting dashboards, performance tracking).
Success Metrics
Provider satisfaction scores
Reduction in provider-related member complaints
Clean claim rate improvements
Reduced authorization friction
Network retention rate
Quality and performance measure improvements
Timely resolution of escalated provider issues
Competencies
Relationship-driven but operationally rigorous
Proactive and field-oriented
Strong problem solver
High accountability
Comfortable in both executive and front-office settings
Data-informed decision maker
WHY THIS ROLE MATTERS The Provider Relationship Manager ensures that the health plan is not just contracted with providers — but truly operationally aligned with them. This role directly impacts:
Member experience
Provider satisfaction
Network performance
Cost and quality outcomes
Brand reputation in the market
This is a mission-critical role for a regional health plan committed to building a high-performing, provider-aligned network.
WHAT WE OFFER
A collaborative and innovative work environment committed to member-centered care.
An organization passionate about improving healthcare delivery in Austin and beyond.
Competitive salary and comprehensive benefits package.
Professional development and opportunities for career growth.
A transparent, supportive, and inclusive culture that values every team member’s contributions.
Harbor Health is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law. We are committed to creating an inclusive environment for all clinicians and teammates and actively encourage applications from people of all backgrounds.
#J-18808-Ljbffr
Regional Health Plan | Provider Relations | Network Operations
COMPANY OVERVIEW At Harbor Health, we’re transforming healthcare in Texas through collaboration and innovation. We’re seeking passionate individuals to help us create a member-centered experience that connects comprehensive care with a modern payment model. If you’re ready to make a meaningful impact in a dynamic environment where your contributions are valued, please bring your talents to our team!
POSITION DUTIES & RESPONSIBILITIES The Provider Relationship Manager serves as the “boots on the ground” representative of the health plan for all in-network provider groups across the region. This role is responsible for ensuring an exceptional member experience by building strong provider relationships, resolving operational issues, improving network performance, and aligning provider groups with the health plan’s strategic objectives.
The Provider Relationship Manager acts as the primary point of contact for in-network practices and works cross-functionally with contracting, claims, credentialing, care management, and member services to proactively remove friction and drive measurable network performance improvements.
This is a highly visible, field-based role that blends provider relations, operational problem-solving, and performance management.
Key Responsibilities 1. Provider Relationship Management
Serve as the primary relationship owner for assigned in-network provider groups
Conduct regular in-person and virtual visits with practices.
Build trust-based partnerships with physicians, practice managers, and administrative leadership.
Represent the health plan in a professional, responsive, and solutions-oriented manner.
Key Responsibilities 2. Member Experience Optimization
Ensure providers understand plan benefits, referral pathways, authorization requirements, and network structure.
Identify and resolve issues that negatively impact member access, scheduling, billing, or care coordination.
Monitor complaints, grievances, and service trends tied to assigned groups.
Proactively intervene to prevent network friction before it impacts members.
Key Responsibilities 3. Operational Issue Resolution
Troubleshoot and resolve claims, eligibility, prior authorization, and billing concerns.
Partner with internal teams to elevate and close provider issues quickly.
Track and trend recurring operational problems and recommend system improvements.
Support clean claims performance and administrative simplification.
Key Responsibilities 4. Network Performance & Accountability
Review provider-level performance metrics (access, quality, cost, utilization).
Support implementation of value-based initiatives and performance programs.
Educate providers on quality measures, documentation, and coding best practices.
Assist with corrective action plans when needed.
Key Responsibilities 5. Network Growth & Retention
Support onboarding of newly contracted provider groups.
Ensure smooth implementation and readiness before go-live.
Monitor provider satisfaction and mitigate termination risk.
Provide field intelligence on competitive dynamics and provider market trends.
Key Responsibilities 6. Cross-Functional Collaboration
Partner with:
Network Contracting
Claims Operations
Care Management
Utilization Management
Member Services
Credentialing
Serve as the feedback loop between the provider community and internal leadership.
QUALIFICATIONS
5+ years experience in:
Provider relations
Network operations
Practice management
Health plan operations
Strong understanding of:
Claims processing
Authorizations
Credentialing
Network adequacy
Value-based reimbursement models
Experience working directly with physician groups and MSOs.
Excellent communication and conflict-resolution skills.
Highly organized with ability to manage multiple provider relationships simultaneously.
Willingness to travel regionally (50–70%).
Preferred:
Experience in regional or startup health plans.
Experience supporting CINs or value-based models.
Data literacy (Excel, reporting dashboards, performance tracking).
Success Metrics
Provider satisfaction scores
Reduction in provider-related member complaints
Clean claim rate improvements
Reduced authorization friction
Network retention rate
Quality and performance measure improvements
Timely resolution of escalated provider issues
Competencies
Relationship-driven but operationally rigorous
Proactive and field-oriented
Strong problem solver
High accountability
Comfortable in both executive and front-office settings
Data-informed decision maker
WHY THIS ROLE MATTERS The Provider Relationship Manager ensures that the health plan is not just contracted with providers — but truly operationally aligned with them. This role directly impacts:
Member experience
Provider satisfaction
Network performance
Cost and quality outcomes
Brand reputation in the market
This is a mission-critical role for a regional health plan committed to building a high-performing, provider-aligned network.
WHAT WE OFFER
A collaborative and innovative work environment committed to member-centered care.
An organization passionate about improving healthcare delivery in Austin and beyond.
Competitive salary and comprehensive benefits package.
Professional development and opportunities for career growth.
A transparent, supportive, and inclusive culture that values every team member’s contributions.
Harbor Health is an Equal Opportunity Employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law. We are committed to creating an inclusive environment for all clinicians and teammates and actively encourage applications from people of all backgrounds.
#J-18808-Ljbffr