Specialist Navigator
Core
Primary liaison between Network Performance and specialist providers, translating data-driven insights into provider action to improve quality, access, affordability, and network outcomes.
Role type
Senior IC specialist network optimization manager
Builds
Efficient, high-performing specialist and ancillary provider networks
Domain
Healthcare insurance + network performance management
Deliverable
production ML models | product features | dashboards & analysis | client delivery | infrastructure
Required skills
provider contracting, rate negotiation, network development, data-driven provider engagement, utilization management, strategic rate negotiations, network enhancements, performance monitoring, behavior change strategy
Preferred skills
experience with value-based care organizations, healthcare consulting, difficult conversations around utilization patterns, driving adoption, influencing behavior change
Technologies
analytics reporting tools, KPI tracking systems
Responsibilities
Develop contracts for specialist and ancillary providers, lead data-driven discussions regarding utilization trends and referral patterns, identify barriers to outpatient utilization, monitor provider adoption of recommended practice changes, track and report key performance indicators including ASC utilization rates and cost savings, provide feedback to leadership on provider performance trends, collaborate with Analytics and Clinical teams on network optimization initiatives.
Seniority
Senior, hands-on IC
