Provider Relations and Performance Specialist III

L.A. Care Health Plan•Los Angeles, CA

3d•$88,854 - $142,166

About The Position

The Provider Relations and Performance Specialist III serves as the primary liaison between L.A. Care Health Plan and its provider network, supporting strategic engagement, operational excellence, provider performance, quality outcomes, organizational priorities, and member experience. The specialist establishes and maintains collaborative relationships with network partners and leads provider-facing interactions, monitors provider satisfaction and performance indicators, and proactively addresses relationship concerns. The role manages complex provider issues from initial intake through root-cause analysis, resolution planning, solution development, implementation, and post-resolution validation. It evaluates provider challenges for financial impact, member implications, regulatory risk, and operational complexity, and develops sustainable, scalable solutions across provider segments. The specialist works with cross-functional stakeholders, uses analytics and operational dashboards to guide provider discussions and improvement strategies, and provides guidance and mentorship to other staff as a subject matter expert. The position also supports consistent provider orientation, onboarding, and ongoing education; facilitates provider forums and operational meetings; reinforces standardized processes and documentation; evaluates business operations and processes; identifies opportunities for technical solutions; provides training; and recommends process improvements. A bachelor's degree in Healthcare Administration or a related field is required, though equivalent education and/or experience may be considered in lieu of a degree. Travel to offsite locations for work is required.

Requirements

Bachelor's degree in Healthcare Administration or a related field; equivalent education and/or experience may be considered in lieu of a degree.
At least 4 years of progressive experience in a health plan, managed care, hospital, physician organization, Independent Practice Association (IPA), or provider relations environment.
Experience managing complex provider relationships and collaborating with senior leadership.
Understanding of managed care operations and delegated risk environments.
Proficiency in developing corrective action frameworks and using operational dashboards to monitor performance, identify trends, and support data-driven improvements.
Strong analytical and problem-solving skills, including root-cause analysis, operational improvement, data interpretation, sound decision-making, and Service Level Agreement (SLA) governance.
Strong communication and relationship-management skills, with the ability to build collaborative partnerships with internal and external stakeholders.
Ability to travel to offsite locations for work.

Nice To Haves

Experience with Medi-Cal, Medicare Advantage, Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA).
Knowledge of capitation, value-based care models, and provider contracting.

Responsibilities

Serve as a primary liaison between the health plan and its provider network, establishing and maintaining collaborative relationships.
Ensure provider orientation, onboarding, and ongoing education are delivered reliably and consistently.
Monitor provider satisfaction indicators and performance trends to identify disputes, operational challenges, and relationship concerns.
Facilitate structured provider forums and operational meetings to promote transparency, clarify complex issues, and strengthen relationships across provider segments.
Manage complex provider issues from intake through root-cause analysis, resolution planning, solution development, implementation, and post-resolution validation.
Evaluate complex provider challenges based on financial impact, member implications, regulatory risk, and operational complexity, and develop sustainable, scalable solutions.
Collaborate with internal partners across cross-functional departments.
Use analytics and operational dashboards to inform provider discussions, identify recurring concerns, and develop measurable, data-driven improvement strategies.
Reinforce standardized processes, documentation practices, and data-driven decision-making to foster accountability, responsiveness, analytical rigor, and service excellence.
Apply subject matter expertise to evaluate business operations and processes and identify where technical solutions could improve performance.
Consult across business operations, mentor staff, and contribute specialized knowledge.
Ensure program deliverables meet departmental and organizational needs as well as applicable legislation, policies, standards, and best practices.
Provide training and recommend process improvements as needed.
Perform other duties as assigned.