Provider Relations Lead - San Antonio, TX

SCAN Health Insurance•Washington, DC

2d•$71,700 - $123,490•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.

Requirements

Bachelor's Degree or equivalent experience
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
Strong technical skills for functional area
Strong problem-solving skills and critical thinking capabilities
Strong communication and interpersonal skills
Strong ability to partner with variety of functions across the enterprise
Strong experience developing relationships with all provider types

Nice To Haves

Curious about AI and its power to transform how we operate and serve our members.

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.
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.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.