Source Job

$115,400–$150,000/yr
US

  • Serve as primary liaison between Network Performance and specialist providers, driving data-driven performance improvements.
  • Develop and maintain trusted relationships with specialists to improve network quality and efficiency.
  • Lead data-driven discussions on utilization trends and referral patterns to achieve cost savings.

Provider Relations Data Analysis Contracting Utilization Management

20 jobs similar to Specialist Navigator

Jobs ranked by similarity.

US

  • Own the end-to-end patient engagement and retention strategy across the full lifecycle from onboarding to long-term retention.
  • Lead cross-functional collaboration with clinical, product, and growth teams to embed engagement best practices.
  • Establish a rigorous measurement framework to drive data-informed interventions that reduce churn and improve outcomes.

Ansible Health is a venture-backed, physician-led virtual medical group revolutionizing care for chronic disease patients. It is a remote-first team of clinicians, engineers, and executives from top institutions.

US

  • Own end-to-end operating model and outcomes for provider engagement and growth programs, ensuring timelines, milestones, and intended results are met.
  • Track program performance through data, translate into concise reports for senior leadership, and provide recommendations for prioritization.
  • Collaborate with cross-functional teams and engage directly with providers and practice staff to maintain momentum and drive program success.

Counterpart Health transforms healthcare with an AI-enabled primary care tool, Counterpart Assistant, that supports earlier diagnosis and management of chronic conditions. As a subsidiary of Clover Health, they have a remote-first culture with a focus on diversity and inclusion, and thousands of practitioners using their tool.

$115,000–$115,000/yr
US

  • Manage UM nurse team performance, SLAs, and quality improvement.
  • Handle escalated UM cases and provider disputes 25% of time.
  • Partner with clients, medical directors, and IDTs to ensure consistent decision-making.

IntusCare builds an end-to-end ecosystem for Programs of All-Inclusive Care for the Elderly (PACE) to improve care, financial performance, and compliance. As a healthcare technology company, we empower teams to improve outcomes for dual-eligible seniors.

$75,000–$85,000/yr
US

  • Supervise and coach a team of Outreach Specialists to meet engagement targets.
  • Conduct call audits and manage performance metrics like schedule rate and show rate.
  • Partner with market teams and drive adoption of new AI tools.

Accompany Health is a primary, behavioral, and social care provider for patients with complex needs, offering at-home and virtual care. They are a fast-paced startup with an empathetic care team, guided by proven care models.

US

  • Architect and advance network solutions integrating network design, payment innovation, and high-performing provider partnerships.
  • Develop value-based payment models and tailored ASO network solutions to optimize total cost of care.
  • Lead provider contract negotiation and mentor a team to execute contracts across the country.

Judi Health is an enterprise health technology company providing a comprehensive suite of pharmacy and health benefit management solutions for employers and health plans. The company is committed to rebuilding trust in healthcare in the U.S. through scalable technology and partnerships.

US

  • Lead the strategy and evolution of external expert engagement in Neuroscience, translating insights into innovative engagement strategies.
  • Collaborate with cross-functional stakeholders to shape business strategy and strengthen brand positioning.
  • Serve as a key point of contact between Medical Experts and Novartis teams, directing engagements and supporting educational programs.

Novartis is a pharmaceutical company focused on improving the lives of people living with disease through innovative science. They are a large, established organization that fosters an inclusive workplace and empowers employees to unleash their full potential.

$145,000–$155,000/yr
US

  • Lead the strategy to secure national payor agreements, moving from state-by-state enrollment to national in-network contracts with major commercial payors.
  • Manage a Credentialing Specialist, setting SLAs and KPIs for credentialing turnaround time, while overseeing payor enrollment and claim denial resolution.
  • Partner with Clinical Ops and Revenue Cycle to align provider onboarding with credentialing lead times and national agreement rollouts.

Happy Health is revolutionizing sleep medicine delivery through a comprehensive telehealth platform that eliminates traditional barriers to sleep care. The company is a fast-moving, low-ego team that values ownership and problem-solving over process, operating remotely with a physical office in Austin, TX.

US

  • Provides visionary leadership and strategic direction for care coordination and service delivery teams.
  • Drives transformational initiatives to scale operations, enhance quality, and improve patient outcomes.
  • Uses data analytics and key performance indicators to monitor program effectiveness and guide evidence-based decision-making.

WellSky is a technology company that provides software, analytics, and services for intelligent, coordinated care across health and community care. The company fosters a culture of independent thinking, collaboration, and innovation, with a focus on improving outcomes and lowering costs.

$130,000–$160,000/yr
US Unlimited PTO 12w maternity 12w paternity

  • Own the program's analytics pipeline including claims records, eligibility files, and MAO-004 reconciliation across all clients.
  • Lead care-gap identification and closure reconciliation, ensuring accuracy for billing and client audits.
  • Deliver practice-level performance analysis and build funnel instrumentation to identify value leakage.

Covera Health combines clinical expertise, advanced AI, and radiology quality data to improve diagnostic accuracy. Backed by Insight Partners, the company supports nearly 6 million people across major employers and health plans, with a culture focused on meaningful work and saving lives.

$204,761–$292,515/yr
US

  • Serve as primary physician reviewer for Utilization Management (UM) cases, advising other reviewers and attending daily calls with health plan teams.
  • Establish 2-3 cases per day for up to 6 markets, ensuring attendance on health plan calls and weekly meetings.
  • Participate in Process and Quality improvement in delegated Utilization Management, utilizing excellent analytical and deductive reasoning skills.

ChenMed is a family-owned, physician-led primary care provider focused on improving healthcare for moderate-to-low-income seniors. The company is rapidly expanding, with a culture of innovation, kindness, and making a difference.

$113,000–$188,000/yr
US

  • Drive customer success for strategic health system members, focusing on adoption, retention, and revenue growth.
  • Build multi-threaded relationships at mid and C-suite levels, and document validated ROI for each account.
  • Analyze data trends, present insightful recommendations, and act as the internal quarterback for customer coordination.

Premier, Inc. is a technology-driven healthcare improvement company serving two-thirds of U.S. healthcare providers. It is a large organization with a culture focused on collaboration and transformation, recognized as a Best Company to Work For by U.S. News & World Report.

US 4w PTO 12w maternity 12w paternity

  • Develop and execute comprehensive GTM launch blueprint for all new and renewing value-based care contracts.
  • Construct explicit implementation timelines and operational workflows from signed contract to active status in the field.
  • Partner with Analytics, Outreach, Provider Networks, and Strategic Payer Partnerships to align priorities and execution.

Aledade, a public benefit corporation, empowers independent primary care practices to thrive in value-based care. Founded in 2014, it has become the largest network of independent primary care in the US, with a collaborative, inclusive, and remote-first culture.

$125,000–$150,000/yr
US

  • Lead and develop a team focused on provider-facing initiatives across Provider Experience and Incentives.
  • Champion the provider perspective and build a provider advocacy function to surface and act on feedback.
  • Develop reporting and insights using data from multiple systems to drive continuous improvement.

BetterHelp is on a mission to remove traditional barriers to therapy and make mental health care more accessible globally. Founded in 2013, the company is the world's largest online therapy service with a network of over 30,000 licensed therapists and a diverse team of clinicians, engineers, and business leaders.

$90,000–$105,000/yr
United States Unlimited PTO

  • Lead the recruitment and activation of a nationwide network of 1099 infusion nurses.
  • Design scalable systems and playbooks for clinician acquisition in new and existing markets.
  • Analyze recruiting economics and funnel metrics to optimize cost, speed, and quality.

Float is the full-stack platform for specialty pharma home infusion, connecting nurses with patients for home medication visits. Over the last 5 years, the company has facilitated over 90,000 patient visits with 1,400 nurses and is scaling its platform and operations across multiple states.

$130,000–$160,000/yr
US Unlimited PTO 12w maternity 12w paternity

  • Own client performance reporting, building recurring packages and performance-review materials from analytics data.
  • Translate performance data into actionable narratives for health plan and provider executives, ensuring disciplined distinctions between submitted and closed.
  • Support growth by identifying expansion opportunities and building business cases for additional services and populations.

Covera Health improves healthcare by making every diagnosis more accurate using clinical expertise, AI, and radiology quality data. Backed by Insight Partners, the company supports nearly 6 million people across Fortune 100 employers and national health plans, with a culture of ambitious, meaningful work.

US

  • Serve as operational second-in-command to the Program Manager, overseeing Specialist teams and driving operational excellence.
  • Analyze KPIs to identify trends and opportunities, then translate data into actionable recommendations.
  • Support process improvement initiatives, including documentation, training design, and system enhancements.

Nightingale Education Group is a nursing school focused on transforming healthcare access through exceptional nursing education. They have graduated nearly 5,000 nurses and emphasize a collaborative culture with professional development and work-life integration.

US

  • Conduct high-volume outbound calls to engage patients and schedule healthcare services, including mammograms and bone density screenings.
  • Identify and address social determinants of health barriers by connecting patients to community resources.
  • Build trust with patients through clear, empathetic communication and ensure completion of care.

Sprinter Health is building the clinical and technological infrastructure to expand access to healthcare through home-based services. We have a rapidly growing team of visionary leaders backed by prominent VCs and advised by industry leaders.

US

  • Review Home Health prior authorization requests for medical necessity using CMS regulations and Clover clinical guidelines.
  • Perform initial and concurrent clinical reviews, ensuring appropriate care in the least restrictive setting.
  • Collaborate with providers and internal teams to support timely decision-making and positive member outcomes.

Clover Health is a healthcare company that uses data and technology to provide affordable, high-quality insurance plans for seniors. The company fosters a remote-first culture with a diverse and mission-driven team focused on improving member outcomes.

US

  • Engage mobile clinics nationwide to join Mobile Health Map, building relationships and providing support to improve data quality and impact measurement.
  • Design and deliver tailored training and resources to help clinic leaders measure and communicate their impact using MHM's analytic tools.
  • Collaborate on research projects, prepare reports, and represent MHM at conferences to advance evidence-based mobile health care.

We are a mobile health clinic founded in 1992, bringing preventive care directly to underserved Boston communities. As part of Harvard Medical School, we support a national collaborative of over 3,600 mobile clinics, fostering a diverse and inclusive environment.

Global

  • Conduct Chronic Care Management follow-up calls and build positive patient relationships.
  • Accurately document patient interactions and maintain tracking logs using Google Drive and Sheets.
  • Coordinate care activities, monitor patient progress, and ensure HIPAA compliance.

SnappyCX provides healthcare staffing and management solutions, specializing in chronic care management and remote patient support. The company is a growing organization that values bilingual, self-motivated professionals in a fully remote, collaborative environment.