Provider Relations Lead - So Cal

SCAN Health Plan•Long Beach, CA

4d•Remote

About The Position

The Provider Relations Lead is responsible for managing and strengthening provider relationships within an assigned geographic region, with a primary focus on executing performance initiatives across quality, cost, utilization, access, and regulatory metrics. This role serves as the primary operational liaison between SCAN and contracted providers, driving performance execution, provider engagement, and the achievement of key performance indicators (KPIs) such as star ratings, cost of care management, and risk adjustment (coding quality). This role is critical to developing deep relationships with providers and understanding how they operate, in order to drive performance. The Provider Relations Lead serves as the primary point of contact and “quarterback” for provider relationships, demonstrating a strong account management mindset and a commitment to exceptional customer service. This individual proactively anticipates provider needs, responds promptly to inquiries, and takes full ownership and accountability for resolving issues and driving results; applies critical thinking and intellectual curiosity to deeply understand provider organizations, exhibiting abilities with navigating complex organizations and building trust with a variety of stakeholders; demonstrates both breadth and depth of knowledge—capable of engaging across a wide range of topics and diving deep to resolve complex challenges as needed; effectively project manage provider needs and initiatives, presenting confidently to diverse provider audiences and tailoring communication strategies to the in different nuanced scenarios order to develop actionable solutions.

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.
Bachelor's Degree or equivalent experience preferred.
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.

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.