Provider Network Manager

Reporting to Manager, Provider Relations, the Provider Network Manager serves as the primary business owner for provider performance and contract enforcement within the Provider Relations domain. You will manage strategic relationships, leading joint operating meetings, and ensuring that provider organizations meet contractual and regulatory obligations. As the subject matter expert on assigned contracts, the Network Manager drives accountability, performance improvement, and understanding of organizational goals.

You bring provider relations experience, excels at handling complex provider issues and escalations, including critical claims and regulatory matters, and is familiar with project management principles. You will monitor provider performance across main domains such as risk adjustment, HEDIS and Stars, delegation reporting, growth, and cost management, and will facilitate training and presentations for both internal and external audiences. You will work with senior leaders to enforce contract and regulatory expectations, serving as a centralized and critical role for provider performance monitoring and implementation of corrective action strategies. We ask that you have collaboration, organizational excellence, a service-oriented outlook. You should, demonstrate and deliver high-quality work.

Please note that while SFHP supports a hybrid work environment, you are required to be onsite and in-office a minimum of 4 days per month. This is a hybrid position, based in our Downtown San Francisco office.

Salary: $88,000 - $103,000 per year

WHAT YOU WILL DO:

• Be the primary contact for assigned provider organizations, encouraging collaborative and professional relationships while delivering exceptional and equitable customer service.
• Lead and facilitate Joint Operations Committee meetings with assigned providers, promoting shared learning and strategic agreement.
• Be the main liaison and trusted subject matter resource for contract terms, performance expectations, and relationship management.
• Monitor, analyze, and communicate provider performance data, including Stars, HEDIS, risk adjustment, delegation reporting, cost effectiveness, and growth metrics, ensuring transparency and mutual understanding.
• Support adherence to contract terms, including administration of performance incentives and implementation of improvement or corrective action plans, with a focus on fairness, accountability, and partnership.
• Manage and resolve complex provider issues and escalations-including claims, compliance, and regulatory matters-with empathy, efficiency, and respect for all parties.
• Develop and implement tailored provider engagement strategies to enhance provider performance, satisfaction, and agreement on organizational values and goals.
• Maintain oversight of all main deliverables related to assigned provider organizations, partnering with other departments to follow-up, and collaborative resolution.
• Collaborate across our teams to lead data-informed strategies and support continuous improvement.
• Facilitate inclusive trainings and presentations that build provider knowledge, promote equity in care delivery, and advance performance improvement.
• Foster communication and active feedback loops with provider organizations and our teams to ensure transparency, responsiveness, and trust.
• Cultivate and strengthen strategic relationships with contracted partners, encouraging shared success and long-term collaboration.
• Help resolve provider inquiries related to claims, contracting, authorizations, tools, member concerns, and compliance requirements.
• Support new provider onboarding and orientation to SFHP programs, systems, and performance expectations, promoting a welcoming and inclusive experience.
• Encourage provider engagement in quality improvement, compliance, and operational programs that enhance the member and provider experience.
• Maintain accurate documentation of provider interactions and resolution activities, supporting accountability and continuity.
• Manage a diverse and high-volume workload, prioritizing tasks and organizational commitments.
• Prepare clear, inclusive, and professional communications and presentations for a variety of internal and external audiences.
• Coordinate field visits, meetings, and follow-up activities.
• Demonstrate a commitment to service excellence in a diverse environment.
• Participate in meetings and programs as assigned, contributing to a culture of collaboration and continuous improvement.

WHAT YOU WILL BRING:

• Bachelor's degree in business administration, healthcare administration, or related field preferred; or equivalent work experience.
• Minimum five years of experience working in health plan operations, managed care environment, health care clinical quality improvement, provider services, customer service, or account management.
• Minimum three years of experience working directly with providers, administrators, and clinical staff in a managed care environment.
• Experience facilitating performance conversations related to risk adjustment, HEDIS, Stars, Compliance, and Medical Management required.
• Experience monitoring Medicare provider performance programs.
• Familiarity with Medi-Cal, Medicare and other government-sponsored health programs.
• Familiarity with Lean project management principles

WHAT WE OFFER:

• Health Benefits
  
  
  
  • Medical: You'll have a choice of medical plans, including options from Kaiser and Blue Shield of California, heavily subsidized by SFHP.
  • Dental: You'll have a choice of a basic dental plan or an enhanced dental plan which includes orthodontic coverage.
  • Vision: Employee vision care coverage is available through Vision Service Plan (VSP).
  
  
  
  
• Retirement - Employer-matched CalPERS Pension and 401(a) plans, 457 Plan.
• Time off - 23 days of Paid Time Off (PTO) and 13 paid holidays.
• Professional development: Opportunities for tuition reimbursement, professional license/membership.

ABOUT SFHP:

Established in 1997, San Francisco Health Plan (SFHP) is an award-winning, managed care health plan whose mission is to provide affordable health care coverage to the underserved low and moderate-income residents in San Francisco County. SFHP is chosen by eight out of every ten San Francisco Medi-Cal managed care enrollees and its 175,000+ members have access to a full spectrum of medical services including preventive care, specialty care, hospitalization, prescription drugs, and family planning services.

San Francisco Health Plan is proud to be an equal opportunity employer. We are committed to a work environment that supports, inspires, and respects all individuals and in which our people processes are applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristics.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

San Francisco Health Plan is an E-Verify participating employer.

Hiring priority will be given to candidates residing in the San Francisco Bay Area and California.

#LI-Hybrid

(Hybrid remote/in-office)

PI279484200