Provider Relations Lead - So Cal

SCAN Health Insurance•Long Beach, CA

11d•$71,700 - $123,490•Remote

About The Position

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

Requirements

5 years of relevant healthcare or Medicare Advantage experience; experience working with provider organizations or healthcare operations; experience with delegated or risk-based provider arrangements; experience supporting provider performance improvement initiatives; experience presenting data to provider or operational audiences.
Provider relationship management experience. Strong experience developing relationships with all provider types.
Data interpretation and performance analysis skills.
Medicare Advantage and Star quality knowledge.
CMS regulatory and compliance awareness.
Ability to manage multiple priorities and concurrent workstreams, effectively multi-task, and remain organized and responsive in a fast-paced dynamic environment,
Escalation management and issue resolution abilities.
Operational execution and follow-through.
Presentation and facilitation skills.
Accountability and ownership mindset.
Strong problem solving skills and critical thinking capabilities
Strong written and verbal communication and interpersonal skills.
Cross functional collaboration skills. Strong ability to partner with variety of functions across the enterprise.
Strong technical skills for functional area. Advanced Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, Access) and Visio.

Nice To Haves

Bachelor's Degree or equivalent experience preferred.

Responsibilities

Acts as the primary operational liaison between SCAN and assigned provider organizations (MSOs, IPAs, medical groups, PCPs, specialists, hospitals, and ancillaries) within a defined geographic region.
Will be responsible for managing FFS network for Southern California.
Executes and monitors regional provider performance initiatives aligned to SCAN’s key performance indicators, including Star ratings, cost of care, utilization management, access standards, and quality measures to improve quality, cost, utilization, access and regulatory compliance to enhance quality, cost, etc.
Conducts regular operational touchpoints and Joint Operating Committee meetings with providers to review performance results, identify gaps, and support action planning.
Partners cross-functionally with Network Contracting, Network Operations, Clinical, Quality, Growth, and Analytics teams to ensure coordinated provider engagement and issue resolution.
Supports provider onboarding and lifecycle management in collaboration with Contracting and Operations, ensuring clarity of performance expectations and operational readiness.
Investigates and resolves provider escalations and operational concerns, escalating complex or high-risk issues to senior leadership when appropriate.
Delivers provider education and training related to SCAN programs, policies, regulatory requirements, performance standards, and operational best practices.
Analyzes provider-level data to identify trends and opportunities, supporting corrective action plans and continuous performance improvement efforts. Utilize operational levers to drive performance improvements such as workflow optimization and process enhancements.
Ensures provider alignment with regulatory, contractual, and compliance requirements, proactively identifying potential risk areas.
Supports internal communication of network changes, provider performance updates, and market-level insights to relevant enterprise stakeholders.
Responsible for managing department Provider Relations Inbox.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.