Provider Relations Lead - So Cal (FUTURE NEED)

SCAN Health Insurance•Long Beach, CA

7d•$71,700 - $123,490•Remote

About The Position

The Provider Relations Lead manages and strengthens provider relationships within an assigned geographic region, with a primary focus on executing performance initiatives across quality, cost, utilization, access, and regulatory metrics. The role is the primary operational liaison between SCAN and contracted provider organizations and is responsible for provider engagement, performance execution, and achievement of key performance indicators such as Star ratings, cost of care management, and risk adjustment coding quality. The position manages the fee-for-service network for Southern California. As the primary point of contact and account-management lead for provider relationships, this role anticipates provider needs, responds to inquiries, and owns issue resolution and results. It builds trust with varied stakeholders, navigates complex organizations, applies broad and detailed knowledge to complex challenges, and project-manages provider needs and initiatives. The role presents confidently to provider audiences and tailors communications to develop actionable solutions. The Provider Relations Lead works with provider organizations and SCAN’s internal teams to review performance, identify gaps, coordinate issue resolution, support provider onboarding and lifecycle management, deliver education, analyze performance data, and promote compliance with regulatory and contractual requirements. This is a mostly remote role. The posting is an evergreen listing for future opportunities and does not indicate an immediate opening.

Requirements

Five years of relevant healthcare or Medicare Advantage experience.
Experience working with provider organizations or in 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 and strong experience developing relationships with all provider types.
Data interpretation and performance analysis skills.
Knowledge of Medicare Advantage and Star quality.
Awareness of CMS regulatory and compliance requirements.
Ability to manage multiple priorities and concurrent workstreams, multitask, 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 and critical-thinking capabilities.
Strong written and verbal communication and interpersonal skills.
Cross-functional collaboration skills and ability to partner with a variety of enterprise functions.
Strong technical skills for the functional area, including advanced Microsoft Office skills (Word, Excel, PowerPoint, Outlook, Teams, and Access) and Visio.
A background check is required.

Nice To Haves

Bachelor’s degree or equivalent experience is preferred.

Responsibilities

Act as the primary operational liaison between SCAN and assigned provider organizations, including MSOs, IPAs, medical groups, PCPs, specialists, hospitals, and ancillary providers in a defined geographic region.
Manage the Southern California fee-for-service network.
Execute and monitor regional provider performance initiatives aligned with SCAN KPIs, including Star ratings, cost of care, utilization management, access standards, quality measures, and regulatory compliance.
Conduct regular operational touchpoints and Joint Operating Committee meetings to review provider performance, identify gaps, and support action planning.
Partner with Network Contracting, Network Operations, Clinical, Quality, Growth, and Analytics teams to coordinate provider engagement and resolve issues.
Support provider onboarding and lifecycle management with Contracting and Operations, ensuring performance expectations and operational readiness are clear.
Investigate and resolve provider escalations and operational concerns, escalating complex or high-risk issues to senior leadership when appropriate.
Deliver provider education and training on SCAN programs, policies, regulatory requirements, performance standards, and operational best practices.
Analyze provider-level data to identify trends and opportunities, support corrective action plans, and drive continuous performance improvement.
Use operational levers, including workflow optimization and process enhancements, to improve performance.
Ensure provider alignment with regulatory, contractual, and compliance requirements and proactively identify potential risks.
Communicate network changes, provider performance updates, and market-level insights to relevant enterprise stakeholders.
Manage the department Provider Relations Inbox.
Actively support the achievement of SCAN’s vision and goals.
Perform other duties as assigned.