Provider Relations Representative

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Job Summary

Under the general supervision of the Regional Director of Network Management, the Specialist, Provider Relations MSO is responsible for managing and coordinating strategic and operational initiatives that support affiliate provider practices, health plan operations, quality improvement programs, and value-based care initiatives within the MSO environment. This role serves as a liaison between internal departments, affiliate provider offices, health plans, and external vendors to ensure operational efficiency, provider engagement, and successful execution of key projects and initiatives. The Specialist, Provider Relations MSO will lead cross-functional projects related to provider operations, HEDIS performance, data management, credentialing coordination, onboarding processes, and system implementations. The ideal candidate possesses strong healthcare operations knowledge, project management experience, HMO payer familiarity, and the ability to manage multiple priorities while driving process improvements and organizational goals.

Essential Duties & Responsibilities

• Lead and manage operational and strategic MSO projects from initiation through implementation and completion.
• Coordinate cross-functional initiatives involving provider relations, credentialing, quality improvement, health plan operations, and data management teams.
• Serve as a primary liaison between affiliate provider offices, internal MSO departments, health plans, and external vendors to ensure project alignment and timely execution.
• Develop project plans, timelines, workflows, and implementation strategies to support organizational objectives.
• Monitor project milestones, deliverables, risks, and dependencies while providing regular status updates to leadership.
• Support provider engagement initiatives and operational improvement strategies across affiliate provider networks.
• Analyze operational workflows and recommend process improvements to increase efficiency, provider satisfaction, and compliance outcomes.
• Assist with the implementation and monitoring of value-based care initiatives, HEDIS performance improvement efforts, and quality metrics.
• Coordinate onboarding activities for new affiliate provider offices, including tracking credentialing progress, system setup, and documentation management.
• Oversee maintenance and accuracy of MSO operational databases, provider directories, SharePoint repositories, and related systems.
• Collaborate with leadership on the preparation and distribution of reports, dashboards, presentations, and project communications.
• Facilitate meetings with affiliate providers, health plans, vendors, and internal stakeholders to support project execution and issue resolution.
• Track and monitor provider-related operational metrics, identifying trends and recommending corrective actions when needed.
• Assist with rollout and implementation of operational tools, system enhancements, workflows, and training materials.
• Ensure compliance with organizational standards, health plan requirements, and regulatory guidelines.
• Maintain project documentation, meeting minutes, implementation records, and operational procedures.

Supervisory Responsibilities

• No supervisory responsibilities

Education & Experience

• Bachelor’s degree in Business Administration, Healthcare Management, Project Management, or related field required.
• Minimum of 3–5 years of experience in healthcare operations, provider relations, project management, network management, or MSO operations.
• Strong understanding of MSO operations, healthcare provider networks, HMO payer processes, and value-based care models.

Education Requirements

Education Level

Discipline

Required

Bachelors Degree

Business Administration, Healthcare Management, Project Management, or related field required.

Knowledge, Skills & Proficiencies

• Experience managing cross-functional projects and operational initiatives in a healthcare environment.
• Knowledge of HEDIS measures, quality improvement programs, credentialing workflows, and provider operations.
• Strong organizational, analytical, and problem-solving skills with the ability to manage multiple projects simultaneously.
• Excellent written and verbal communication skills with strong stakeholder management abilities.
• Proficiency in Microsoft Office Suite, SharePoint, project management tools, and healthcare operational systems/EMRs.
• Ability to analyze data, identify operational trends, and develop actionable recommendations.
• PMP certification or formal project management training preferred.

Physical Requirements

This position works under usual office conditions. The associate is required to work at a personal computer as well as be on the phone for extended periods of time. Must be able to stand, sit, walk and occasionally climb. The incumbent must be able to work extended and flexible hours and weekends as needed. Physical demands include ability to lift up to 50 lbs. The physical demands described here are representative of those that must be met by an associate to successfully perform the essential functions of the job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Conditions

Must be able to perform essential functions such as typing, standing, sitting, stooping, and occasionally climbing. 

Travel Requirements

Amount of Expected Travel

Details

Yes

0 - 25%

Flexibility to travel to clinical sites as needed

Tools & Equipment Used

Computer and peripherals, standard and customized software applications and tools, and usual office equipment.

Disclaimer

The duties and responsibilities described above are designed to indicate the general nature and level of work performed by associates within this classification. It is not designed to contain, or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of associates assigned to this job. This is not an all-inclusive job description; therefore, management has the right to assign or reassign schedules, duties, and responsibilities to this job at any time. Cano Health is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to sex, gender identity, sexual orientation, race, color, religion, national origin, disability, protected veteran status, age, or any other characteristic protected by law.

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