Provider Relations and Performance Specialist II

L.A. Care Health Plan•Los Angeles, CA

3d•$77,265 - $123,625•Onsite

About The Position

The Provider Relations and Performance Specialist II is a key driver of provider engagement and operational excellence. This position builds purposeful, transparent relationships with providers, ensuring alignment with organizational goals. The Specialist II strengthens provider relationships and accountability by supporting onboarding, guiding providers through health plan operational processes, and accurately documenting concerns and issues for timely escalation and resolution. The Specialist manages structured issue intake and proactive communication to provide timely updates to providers and internal stakeholders, support efficient issue resolution, and identify opportunities for continuous improvement. This position collaborates across departments to identify and remove administrative barriers, improve operational processes, and support overall provider, member, and organizational performance.

Requirements

At least 3 years of experience in a health plan, managed care, hospital, physician organization, Independent Practice Association (IPA), or provider relations environment.
Working knowledge of managed care operations and delegated risk arrangements.
Strong communication, relationship‑building, and problem‑solving skills.
Ability to document provider concerns clearly and categorize issues appropriately.
Strong teamwork, accountability, adaptability, and customer-focused service skills, with the ability to collaborate effectively, respond to changing priorities, and deliver high-quality support to providers and internal stakeholders.

Nice To Haves

Experience with Medi‑Cal, Medicare Advantage, Department of Managed Health Care (DMHC), Department of Health Care Services (DHCS), Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA).
Knowledge of provider contracting and health system partnerships.

Responsibilities

Fosters collaborative relationships with the organization’s provider network, aligning provider engagement activities with strategic objectives, and supporting operational excellence across the network.
Manages provider onboarding and orientation activities by delivering clear, actionable education on policies, workflows, and essential tools. Guides providers through administrative requirements, operational updates, and process changes, while maintaining documentation of provider inquiries, concerns, and recurring issues to support timely escalation and resolution.
Identifies recurring provider concerns and operational trends and escalates systemic or complex issues to appropriate business areas. Ensures provider concerns are accurately categorized and documented. Participates in operational meetings. Provides timely status updates to providers and internal stakeholders throughout the issue resolution process, ensuring transparency, maintaining accountability, and fostering trust in provider relationships.
Collaborates across internal teams to communicate provider questions and concerns, identify administrative barriers, monitor progress toward issue resolution, and gather and share provider feedback to support continuous improvement and enhance organizational performance.
Monitors provider activities for alignment with contractual, operational, regulatory, and organizational requirements and escalates potential compliance concerns as appropriate.
Performs other duties as assigned.