Senior Manager, Provider Relations and Performance Management

L.A. Care Health Plan•Los Angeles, CA

3d•$135,136 - $216,218

About The Position

The Senior Manager, Provider Relations and Performance Management drives organizational excellence through strategic provider engagement and performance oversight. The role establishes clear provider accountability, structured engagement, and actionable performance information while addressing operational concerns and upholding contractual obligations. It develops tailored account management strategies, leads joint operating and performance review meetings, and provides a differentiated provider experience focused on operational processes and relationship priorities. It also establishes a performance management model that aligns provider objectives with organizational goals and translates performance data into clear expectations and improvement plans. The Senior Manager operates independently, manages routine and team matters, escalates material provider risks and unresolved concerns, and serves as a management-level escalation point. The role promotes ownership, accountability, proactive management, and measurable improvement while maintaining professionalism and consistency in interactions. The position manages the department’s staff and day-to-day activities, including hiring, supervision, coaching, training, performance management, corrective action, mentoring, and staff development. It oversees departmental programs, policies, and procedures, participates in budgeting, manages department budgets, and collaborates with senior and executive management to set goals and develop projects and programs. The role also manages complex projects, develops timelines, coordinates stakeholders and deliverables, and plans systems and procedures to improve operating efficiency and achieve strategic priorities.

Requirements

Bachelor's degree; equivalent education and/or experience may be considered in lieu of a degree.
At least 7 years of extensive experience in provider relations, account management, and performance oversight within healthcare or managed care.
At least 5 years of experience leading, supervising, and/or managing staff.
Experience leading teams, projects, initiatives, or cross-functional groups.
Experience developing tailored strategies, leading structured provider meetings, and proactively managing relationships.
Experience in performance management, including quality assessment, compliance, and improvement planning.
Strong leadership skills, independent decision-making, and a track record of fostering accountability and data-driven improvement.
Strong expertise in provider relations, account management, and performance oversight within healthcare or managed care.
Advanced proficiency in performance management, including quality assessment, compliance, and improvement planning.
Exceptional communication, professionalism, and consistency in interactions.
Strong interpersonal skills and ability to build relationships, foster teamwork, create a positive work environment, and guide and support team members.
Ability to set clear goals, develop strategic plans, and inspire others toward a shared vision.
Skill in mediating disputes and resolving conflicts fairly and constructively.
Deep understanding of financial principles.
Ability and knowledge to develop and manage budgets, forecast financial outcomes, and make informed resource-allocation decisions.
Demonstrated ability to make informed decisions.
Strong verbal, written communication, and presentation skills.
Understanding of the industry, market dynamics, and organizational operations to identify opportunities and navigate challenges.
Ability and knowledge to analyze market trends, anticipate changes, and develop long-term strategies aligned with company goals.
Light physical requirements.

Nice To Haves

Master's degree.
Experience with large, complex provider networks and multifaceted operational environments.
Knowledge of regulatory requirements, contractual performance standards, and advanced data analytics.
Ability to foster ownership, proactive management, and measurable improvement, along with strategic thinking and adaptability in dynamic organizational contexts.

Responsibilities

Develop and implement provider account management strategies tailored to provider size, membership, utilization, performance, network importance, operational complexity, and relationship needs.
Proactively manage provider relationships and deliver a provider experience focused on operational processes, performance expectations, and relationship concerns.
Establish and lead structured joint operating and performance review meetings with providers, emphasizing priorities, actionable data, decision-making, accountability, and measurable outcomes.
Establish and oversee performance management covering quality and clinical performance, member access, utilization, member experience, operational responsiveness, care coordination, data submission and reporting, contractual performance, and regulatory compliance.
Set provider-specific performance objectives and priorities aligned with organizational goals, and translate performance information into clear, actionable expectations.
Equip teams to interpret performance data and translate findings into effective provider discussions.
Develop and oversee provider improvement plans, including deficiencies, expected outcomes, milestones, responsible parties, and timelines; intervene when improvement is insufficient.
Escalate material provider risks, sustained underperformance, significant relationship deterioration, and matters requiring executive intervention.
Serve as a management-level escalation point for unresolved provider concerns and foster ownership, accountability, proactive management, data-driven decisions, and measurable improvement.
Manage staff and departmental day-to-day activities, including scheduling, hiring, training, performance, corrective actions, mentoring, and development.
Participate in the department budgeting process and oversee and manage departmental budgets.
Oversee the development, implementation, administration, and maintenance of departmental programs, policies, and procedures.
Collaborate with senior and executive management to establish goals aligned with the organization's mission and vision, and to define, prioritize, and develop projects and programs.
Identify complex problems, evaluate options, and implement solutions.
Manage complex projects, engage and update stakeholders, develop timelines, lead delivery of work on time, and ensure implementation upon approval.
Plan and implement systems and procedures to maximize operating efficiency and achieve strategic priorities.
Perform other duties as assigned.