Provider Relations Lead

Duties and Responsibilities

Provider Network Oversight

• Serve as the primary liaison for all providers in the assigned region, ensuring network issues are addressed promptly.
• Lead, coach, and support Provider Relations Representatives in their daily activities, including provider training, field observations, and compliance monitoring.
• Ensure providers follow policies, procedures, and service expectations.
• Conduct quarterly reviews with providers to assess performance, address concerns, and strengthen relationships.
• Oversee credentialing compliance and maintain accurate provider documentation.
• Review provider performance reports, including On-Time Performance (OTP), missed trips, and driver adherence metrics, and implement improvement plans as needed.

Network Adequacy & Growth

• Identify gaps in provider coverage and develop strategies to recruit, negotiate, and contract new providers.
• Maintain adequate provider coverage in assigned regions to meet Health Plan requirements.
• Support PRRs in recruiting and onboarding providers.

Field & Compliance Leadership

• Conduct or oversee field observations to monitor vehicle safety, provider performance, and service quality.
• Ensure PRRs complete scheduled facility visits and provider observations.
• Investigate escalated complaints or operational issues and implement corrective actions.

Team Management & Reporting

• Supervise and mentor PRRs, setting goals, providing feedback, and monitoring performance.
  • Ensure all provider-related reports and operational data are submitted accurately and on time.
  • Analyze network performance metrics and identify opportunities for improvement.
  • Act as the primary point of escalation for provider or facility concerns.

Other Responsibilities

• Travel to provider’s offices and facilities as required.
• Perform other duties as assigned to support network operations and company goals.

Requirements & Qualifications:

• High school diploma or equivalent required; bachelor’s degree preferred.
• Bilingual (English/Spanish) preferred.
• Minimum of 3–5 years of experience in provider relations, NEMT operations, or healthcare network management.
• Experience managing or supervising a team preferred.
• Strong knowledge of Microsoft Word, Excel, PowerPoint, Outlook, and CRM systems (e.g., Salesforce).
• Excellent leadership, communication, customer service, problem-solving, and analytical skills.
• Ability to work independently and collaboratively in the field or office.
• Observational, investigative, and process-oriented with attention to detail.
• Knowledge of vehicle safety, inspection standards, and operational compliance protocols.