Registered Nurse Provider Support Specialist

About This Role

Serve as a clinical liaison to contracted primary care practices, driving value-based care performance and reducing avoidable utilization through proactive patient outreach, interventions, and improved provider engagement. This role focuses on supporting practices in managing high-risk patients and implementing population health strategies.

Responsibilities

• Manage patient census across assigned practices, focusing on high-risk and high-cost cohorts
• Monitor and influence key utilization metrics such as ER visits, Admits/K, Readmits/K, SNF/ASC/hospital usage, and palliative care engagement
• Serve as a liaison between PCPs, hospitalists, specialists, and care management programs to ensure coordinated care delivery
• Support practices in implementing contingency plans for high-risk patients, including documentation of advanced directives and care bundle elements
• Conduct weekly touchpoints with the medical director dyad partner to review admissions and determine escalations to contracted providers
• Analyze utilization and performance data to identify trends and root causes in partnership with PBM and Medical Director team
• Develop action plans aligned with market goals (quality, cost, coding)
• Produce and share scheduled/ad-hoc reports on key metrics
• Ensure monthly visits for Band 5 and other high-risk cohorts per prioritization list
• Facilitate timely follow-up for hospital discharges and transitions of care

Requirements

• Associates Degree in Nursing
• Current, unrestricted RN license specific to the state of employment or compact license within 30 days of hire
• 4+ years in provider relations or network management
• Experience with Medicare Advantage, HEDIS, STAR, CMS reimbursement models, risk adjustment
• Solid analytics, communication, relationship-building skills
• Proficiency in Microsoft Office
• Ability to travel extensively (up to 75-85%)
• Valid driver's license issued by the state of practice

Qualifications

• Associates Degree in Nursing
• 4+ years in any combination of provider relations, network management

Nice to Have

• Bachelor's degree in Business or Healthcare Administration
• CPC Certification
• Experience in value-based care or population health management, care management, and/or clinical operations

Skills

* Required skills

Benefits