Sr. Provider Relations Representative

Essential Functions

The Senior Provider Relations Representative is responsible for managing and strengthening strategic relationships across ClareMedica’s specialty and ancillary provider network. This role serves as a key liaison between ClareMedica and high-profile provider partners, including large multi-specialty physician groups, ancillary facilities, ambulatory surgery centers (ASCs), imaging centers, diagnostic facilities, and other contracted network providers. The Sr. Provider Relations Representative plays a critical role in supporting network integrity, provider performance, operational alignment, referral management initiatives, and overall provider satisfaction.

• Serve as the primary point of contact for escalated provider operational concerns, network issues, and service-related matters
• Support provider onboarding, orientation, and ongoing education related to ClareMedica processes, referral workflows, policies, and operational initiatives
• Carefully coordinate closely with internal operational, contracting, credentialing, referral management, and clinical leadership teams to ensure provider alignment and network performance
• Aid in the implementation and oversight of specialty network initiatives focused on network fidelity, access, utilization management, and provider engagement
• Maintain accurate provider records, network data, and provider documentation within applicable systems and databases
• Coordinate provider meetings, site visits, and relationship management activities across assigned markets
• Aid in the resolution of issues involving scheduling, eligibility, referrals, credentialing, claims, provider data, and operational workflows
• Support provider audits, recredentialing activities, and network reporting initiatives
• Collaborate with leadership on strategic provider partnership development and network expansion opportunities
• Support communication and coordination related to in-house specialist scheduling and ancillary service alignment
• Represent ClareMedica professionally in provider-facing meetings and regional market interactions

Qualifications

• Bachelor’s degree
• Minimum 5+ years of provider relations, healthcare network operations, managed care, or related healthcare experience
• Experience managing relationships with specialty physician groups, ancillary providers, ASCs, diagnostic facilities, and/or multi-site healthcare organizations strongly preferred
• Must speak English & Spanish fluently
• Strong understanding of healthcare operations, managed care, referral workflows, and provider network management
• Excellent communication, presentation, organizational, and relationship management skills
• Ability to manage multiple priorities and work effectively in a fast-paced environment
• Strong problem-solving skills with the ability to independently manage escalated provider issues
• Proficient in Microsoft Office and healthcare systems/platforms