Senior Director, Chief Provider Engagement and Performance

L.A. Care Health Plan•Los Angeles, CA

3d•$247,573 - $420,875•Onsite

About The Position

The Senior Director, Chief Provider Engagement & Performance provides strategic leadership, direction, and oversight. This position is responsible for advancing the strategy, structure, and effectiveness of provider relationships and engagement. Develops strategic plans, drives change and influences critical business outcomes. Primary focus on strengthening the health and stability of long-term partnerships across a defined portfolio of providers through building and maintaining transparent and trusting relationships, working with cross functional leadership to ensure the network is poised for success across hospitals, health systems, physician organizations, IPAs, medical groups, delegated entities, and other contracted partners. The Senior Director functions as the organization’s senior relationship developing long-term, strategic partnerships that support improvements in cost, quality, access, utilization, operational excellence, and member experience. Through structured engagement models, clear accountability, and proactive leadership, the Senior Director translates organizational strategy, regulatory obligations, member needs, and performance expectations into measurable outcomes across the provider network. Steers top-level decision-making and implement initiatives that drive organization's forward. Directs operations, ensuring efficiency and effectiveness. This position is responsible for directing all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct reports.

Requirements

At least 10 years of progressively responsible experience within health plans, hospital systems, provider organizations, IPAs, or healthcare consulting environments.
At least 10 years of leading staff, supervising staff and/or people management experience.
At least 5 years leading provider engagement, provider performance, contracting, managed care operations, or network management functions.
Experience with managed care, provider network management, provider relationships, value‑based care, and performance improvement.
Demonstrable experience working directly with senior provider executives and possesses a deep understanding of the financial, operational, and clinical dynamics that drive provider performance.
Strong executive relationship management, negotiation, and conflict‑resolution skills.
Advanced strategic planning and change‑management abilities.
Ability to design long‑range engagement models, guide organizational alignment, and ability to lead cross‑functional improvement initiatives.
Deep subject‑matter expertise in managed care operations and provider contracting, network management.
Knowledge of value‑based care methodologies, delegated risk arrangements, quality improvement frameworks, healthcare reimbursement mechanics, and the financial/operational dynamics that shape provider performance.
Robust analytical capability is essential, including the ability to synthesize complex claims, utilization, quality, and financial data into actionable insights and to develop dashboards, performance scorecards, benchmarks, and root‑cause analyses.
Ability to deliver clear, compelling executive‑level presentations, facilitate high‑stakes provider discussions.
Ability to translate technical information into accessible recommendations and develop executive reports for senior leadership and governing bodies.
Ability to influence decision‑making, drive measurable improvements, and establish strategic, trust‑based provider partnerships.
Demonstrated ability to think long-term and develop strategies that align with the overall goals of the organization.
Demonstrated ability to make sound and timely decisions.
Demonstrated ability to adapt to changing situations and adjust strategies accordingly
Demonstrated ability to adapt to a fast-paced and evolving environment and to lead others through change.
Excellent written and verbal communication, negotiation, and interpersonal skills.
Excellent interpersonal skills for building relationships, fostering teamwork, and creating a positive work environment.
Excellent ability and knowledge in analyzing data, identifying problems, and making informed decisions, often in complex or ambiguous situations.
Travel to offsite locations for work required.

Nice To Haves

Master's Degree
Experience with Medi‑Cal, Medicare Advantage, or other government‑sponsored programs; expertise with IPAs, medical groups, capitated arrangements, and value‑based incentive designs; and familiarity with HEDIS, CAHPS, population‑health analytics, quality incentive programs, and advanced utilization‑management strategies.
Prior experience presenting to executive leadership and Boards of Directors, reflecting comfort operating in highly visible, strategic settings.
Refined financial modeling skills related to provider reimbursement and risk‑sharing models.

Responsibilities

Leads a comprehensive provider engagement strategy that elevates relationships from transactional interactions to strategic partnerships grounded in shared accountability.
Establishes formal engagement mechanisms—such as executive business reviews, partnership forums, advisory councils, joint operational meetings, and structured feedback loops that strengthen communication, deepen collaboration, and foster executive‑level alignment across provider organizations.
Cultivates high‑impact relationships with key stakeholders at all levels, ensures provider priorities are understood and integrated into broader organizational decision‑making.
Creates and provides oversight of a holistic provider performance management framework integrating quality outcomes, utilization trends, cost efficiency, access standards, care coordination, claims performance, operational reliability, member experience, and regulatory and contractual requirements.
Ensures performance data is timely, accurate, and actionable.
Develops dashboards, scorecards, benchmarks, and comparative assessments that translate complex analytics into meaningful insights.
When gaps appear in performance, leads structured improvement processes that include root‑cause evaluation, development of corrective action plans, establishment of milestones, and monitoring of measurable progress until sustained improvement is achieved.
Advances operational effectiveness by identifying systemic provider friction points across claims payment, prior authorization, referral management, credentialing, provider data accuracy, EDI transactions, provider portal utilization, customer service interactions, documentation requirements, quality reporting, care management workflows, and payment reconciliation.
In partnership with cross‑functional departments leads initiatives to streamline processes, resolve recurring issues, and elevate the overall provider experience across the enterprise.
Strengthens strategic provider partnerships, accelerating value‑based care.
Collaborates with cross functional groups to design and manage value‑based programs such as shared savings, shared risk, capitation arrangements, pay‑for‑performance initiatives, and bundled payment models.
Provides clear communication of attribution methodologies, quality benchmarks, incentive structures, and performance expectations.
Ensures providers are equipped to succeed under evolving payment models.
Facilitates collaborative initiatives related to quality improvement, avoidable utilization, care transitions, complex case management, behavioral health integration, population health priorities, and social determinants of health, deepening the shared commitment to improving member outcomes.
Serves as escalation point for complex provider issues.
Oversee teams responsible for resolution of disputes involving claims, authorization delays, payment discrepancies, credentialing barriers, access challenges, communication breakdowns, provider data concerns, referral processes, and care coordination.
Develops and implements a structured dispute‑resolution framework that incorporates root‑cause analysis, corrective action planning, ownership assignment, escalation pathways, and time‑bound resolution standards.
Ensures resolution of systemic issues and implements sustained long‑term improvements.
Provides oversight and governance, ensures alignment with Medi‑Cal, Medicare, DMHC, DHCS, CMS, NCQA, and other regulatory requirements.
Collaborates with cross functional teams and internal stakeholders to ensure provider performance and engagement activities comply with contractual, operational, and regulatory standards.
Provides reports to senior leadership and the Board, translating complex operational, financial, utilization, and quality data into strategic insights that inform decision‑making.
Leads discussions on policy operationalization and oversee key policy perspective sharing.
Conducts strategic planning to utilize resources to meet current and future departmental and Enterprise-wide goals.
Identifies and drives change initiatives.
Builds and leads a high‑performing Provider Engagement and Performance team.
Establishes departmental goals, operating plans, budgets, professional development expectations, and a culture grounded in accountability, transparency, and collaboration.
Responsible for the hiring, performance reviews, salary reviews and disciplinary matters for direct reporting employees.
Ensures the team is prepared to manage strategic relationships and execute improvement initiatives with excellence.
Represents the health plan in external meetings, strategic partnership forums, community engagements, and provider executive discussions on behalf of the organization.
Performs other duties as assigned