Commonwealth Care Alliance · 1 day ago
Director, Provider Relations
Boston, MA
Full-time
Hybrid
Director/Executive
$134K/yr - $200K/yr
8+ years expCommonwealth Care Alliance is seeking a Director of Provider Relations to lead the strategic vision and operational execution of provider relations. This role involves cultivating relationships with healthcare providers, optimizing network performance, and ensuring compliance with regulatory standards while enhancing operational engagement and member access.
Health CareHospitalMedical
Responsibilities
Develop and execute the organization’s provider relations strategy, ensuring strong, collaborative partnerships with hospitals, physician groups, LTSS, HCBS, behavioral health, and ancillary providers
Serve as the primary point of contact for high-priority provider groups, resolving escalated and complex issues with a focus on long-term satisfaction and retention
Lead ongoing communication efforts, working closely with Provider Communications Manager, to keep providers informed of organizational objectives, regulatory updates, operational changes, and compliance requirements
Establish and oversee a structured process for tracking, escalating, and resolving provider issues in coordination with network, operational, clinical, and compliance teams
Collaborate with contracting, operations, and analytics teams to monitor network performance against internal and regulatory benchmarks
Ensure provider network compliance with CMS, state Medicaid agency, and NCQA standards
Lead initiatives to streamline provider operations, reduce administrative burden, and improve the overall provider experience
Analyze trends in provider inquiries and grievances to identify root causes, recommend process improvements, and enhance provider satisfaction and performance
Partner with senior leaders to communicate resolution and outcomes and drive cross-functional accountability for systemic improvements
Ensure all issue resolution processes align with regulatory requirements and organizational standards for service quality and responsiveness
Collaborate with Provider Communications, Provider Engagement and Delegation in the development and execution of a comprehensive provider education strategy
Oversee the design and delivery of high-impact training programs, webinars, and materials that strengthen provider understanding of CCA’s model of care, operations, and compliance standards
Partner with internal stakeholders to ensure educational initiatives support system-wide consistency and continuous improvement
Leverage data and provider feedback to identify educational needs, measure effectiveness, and adapt programs for maximum impact
Represent CCA as a thought leader in provider education at meetings, forums, and partnerships
Ensure provider education efforts foster collaboration, shared accountability, and a culture of partnership across the network
Support Provider Engagement and Delegation Partnerships in the implementation and performance monitoring of value-based arrangements, including shared savings, risk-sharing, and quality incentive programs
Partner with provider engagement, delegation partnerships, clinical and population health teams to drive provider engagement in quality improvement and care coordination initiatives
Manage, mentor, and develop a team of provider relations account managers and representatives, setting clear goals and performance metrics aligned with organizational priorities
Foster a culture of continuous improvement, professional development, and high performance within the provider relations team
Work closely with network contracting, credentialing, claims, IT, customer service, compliance, and quality teams to address provider needs and improve service delivery
Lead or support provider advisory councils and feedback mechanisms to integrate provider perspectives into strategic planning
Lead provider operations joint operating committee to ensure provider escalations and operational issues are addressed timely and effectively
Represent Provider Network in collaborative forums and committees, including payment policy and medical policy
Develop and maintain SOPs related to provider mailings, education and escalations support
Support departmental projects and initiatives as assigned
Represent the Provider Relations teams in cross-functional meetings and external stakeholder discussions
Qualification
Required
Bachelor's degree in healthcare administration, business administration, public health, or a related field required
8–10 years of progressively responsible experience in provider relations, network management, or healthcare operations within a managed care organization, health plan, or integrated delivery system
Demonstrated success building and managing provider partnerships across multiple provider types (e.g., primary care, specialty, behavioral health, hospitals, and community-based organizations)
Proven ability to analyze provider performance metrics, identify improvement opportunities, and drive accountability to outcomes
Experience resolving escalated provider issues, collaborating cross-functionally to address root causes, and improving overall provider satisfaction
Track record of leading provider education and engagement initiatives, including provider communications, trainings, and forums
Demonstrated leadership and team management experience, with the ability to develop staff and lead through influence across departments
Strong understanding of claims processing, reimbursement methodologies, and payment policies, with the ability to interpret and communicate their impact on provider operations and satisfaction
Strong understanding of Medicare and Medicaid health plan operations, including regulatory and compliance requirements
Demonstrated analytical and data interpretation skills, with the ability to translate performance data into actionable strategies
Excellent communication and relationship management skills, with the ability to influence diverse internal and external stakeholders
Skilled in conflict resolution and issue escalation management, maintaining professionalism and diplomacy under pressure
Exceptional organizational, problem-solving, and project management abilities with a focus on results and accountability
Proficiency in Microsoft Office Suite (Excel, PowerPoint, Word) and comfort with data dashboards or reporting tools
Ability to lead and facilitate provider meetings, deliver presentations to executive audiences, and represent the organization at external events
Strong collaboration skills and the ability to work effectively across clinical, operational, contracting, and quality teams
Demonstrated professional presence and strategic thinking in a matrixed environment
Ability to manage multiple priorities, adapt to changing business needs, and maintain attention to detail in a fast-paced setting
Proactive in identifying issues and developing effective solutions
Adaptable and able to thrive in high-pressure environments, adjust to shifting priorities, and manage multiple deadlines
Results-oriented and self-motivated, with the ability to work independently and as part of a team to meet departmental goals
Demonstrates empathy, self-awareness, and the ability to navigate sensitive conversations diplomatically
English
Preferred
Master's degree in healthcare administration, business administration, public health, or a related field required
Experience with dual-eligible (DSNP) populations preferred
10+ years of experience in provider relations, contracting, or network operations, including 3–5 years in a director or senior management role
Experience with value-based payment models, performance-based contracting, or population health initiatives
Prior work with hospital systems, large medical groups, and specialty care networks
Experience supporting provider data integrity, onboarding, and credentialing processes
Proven success in network development or market expansion initiatives
Experience developing and executing provider engagement strategies aligned with network performance goals
Familiarity with CRM systems (e.g., Salesforce) and provider relationship management tools
Understanding of claims operations, utilization management, and quality programs as they relate to provider satisfaction and network performance
Experience with change management and process improvement methodologies
Knowledge of healthcare economics, reimbursement structures, and financial performance metrics
Demonstrated commitment to equity, inclusion, and community partnership in provider engagement
Experience working cross-functionally with claims, finance, and contracting teams to address provider payment inquiries, resolve escalations, and implement process improvements related to reimbursement accuracy and timeliness
Benefits
You may qualify for a bonus tied to company and individual performance.
Substantial and comprehensive total rewards package.
Company
Commonwealth Care Alliance
Commonwealth Care Alliance is an integrated care system that advocates for economical healthcare policies.
1001-5000 employees
H1B Sponsorship
Commonwealth Care Alliance has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (11)
2024 (16)
2023 (11)
2022 (18)
2021 (21)
2020 (15)
Funding
Current Stage
Late StageTotal Funding
$1.77MKey Investors
The Robert Wood Johnson Foundation
2025-04-09Acquired
2019-11-11Grant· $1.77M
Leadership Team
Amanda Cassel Kraft
Chief Operating Officer
Don Stiffler
Chief Revenue and Growth Officer
Recent News
2025-12-29
Press Telegram
2025-12-03
Company data provided by crunchbase