Provider Performance Specialist Senior

About this role

Job Summary

The Senior Specialist, Provider Network Management is responsible for building and maintaining strategic relationships with Priority Health's most complex provider partners. This role serves as a trusted advisor to providers and internal stakeholders, leading the resolution of complex operational challenges while supporting quality and provider incentive programs.

The Senior Specialist demonstrates advanced healthcare industry knowledge, strong business acumen, and the ability to influence outcomes across departments. This individual serves as a mentor to team members, an Epic Super User, and a key contributor to provider engagement.

Essential Responsibilities Account Ownership & Provider Relationships • Serve as the primary relationship owner for Priority Health's largest, most complex provider partners.

• Build trusted partnerships with executive and operational leaders.

• Lead Joint Operating Committees (JOCs) and operational forums.

• Anticipate provider needs, identify emerging risks, and proactively develop solutions.

Complex Operational Issue Resolution • Lead the resolution of complex provider operational issues involving multiple internal and external stakeholders.

• Navigate ambiguity while maintaining productive relationships.

• Facilitate cross-functional problem-solving.

• Escalate and manage issues appropriately to ensure timely resolution.

Quality & Provider Incentive Programs • Serve as a subject matter expert for provider incentive programs.

• Partner with providers to support performance improvement efforts and program understanding.

• Interpret and communicate quality and incentive program results, opportunities, and operational impacts.

• Support implementation of strategic initiatives that improve provider and member outcomes.

Epic & Process Leadership • Function as an Epic Super User.

• Identify opportunities to improve operational efficiency and provider experience.

• Provide recommendations to reduce provider abrasion.

Team Development & Leadership • Onboard and mentor new team members.

• Share best practices and operational knowledge across the Provider Network Management team.

• Provide guidance and informal leadership on complex provider issues and escalations.

• Serve as a resource and coach for Specialists and newer team members.

Qualifications

Required • Bachelor's Degree in health care administration, business administration, accounting, finance, clinical or health and human services or equivalent education and experience

• 5 years of relevant experience of either provider network management experience, health care insurance or other health care delivery setting

• 2 years of relevant experience directly interacting in a clinical environment

Preferred • Provider or Payer experience.

• Experience with provider incentive programs.

• Experience facilitating executive-level meetings.

• Experience managing complex provider relationships and operational challenges.

• Demonstrated ability to lead meetings, presentations, and stakeholder discussions.

• Strong analytical and problem-solving skills.

• Familiar with Microsoft Excel skills, including V Lookups and Pivot Tables

• Excellent written and verbal communication skills.

• Ability to influence without direct authority.

• Experience with Quality programs.

About Corewell Health As a team member at Corewell Health, you will play an essential role in delivering personalized health care to our patients, members and our communities. We are committed to cultivating and investing in YOU. Our top-notch teams are comprised of collaborators, leaders and innovators that continue to build on one shared mission statement - to improve health, instill humanity and inspire hope. Join a nationally recognized health system with an ambitious vision of continued advancement and excellence.

How Corewell Health cares for you • Comprehensive benefits package to meet your financial, health, and work/life balance goals. Learn more here . • On-demand pay program powered by Payactiv • Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more! • Optional identity theft protection, home and auto insurance • Traditional and Roth retirement options with service contribution and match savings • Eligibility for benefits is determined by employment type and status

Primary Location SITE - Priority Health - 1239 E Beltline Ave NE - Grand Rapids Department Name Provider Network Management - PH Managed Benefits Employment Type Full time Shift Day (United States of America) Weekly Scheduled Hours 40 Hours of Work 8 a.m. to 5 p.m. Days Worked Monday to Friday Weekend Frequency N/A CURRENT COREWELL HEALTH TEAM MEMBERS – Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.

Corewell Health is committed to providing a safe environment for our team members, patients, visitors, and community. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process, to perform the essential functions of a job, or to enjoy equal benefits and privileges of employment due to a disability, pregnancy, or sincerely held religious belief.

Corewell Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, gender, pregnancy, sexual orientation, gender identity or expression, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advoc

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