Sr. Provider Relations Lead, California

SCAN Health Insurance•California, MO

2d•Remote

About The Position

The Senior Provider Relations Lead is responsible for strategic performance governance and executive-level relationship management for high-complexity provider groups within an assigned geographic region. This role drives measurable outcomes across quality, cost, utilization, access, and regulatory performance while serving as the primary senior liaison between SCAN and provider leadership. The Senior Lead provides oversight across markets, identifies performance trends, and ensures consistent execution of provider performance initiatives. This role also serves as a subject-matter leader, coaching and developing other Provider Relations Leads and elevating overall team effectiveness. The Senior Provider Relations Lead has proven experience developing relationships with providers and understanding their operations to drive performance improvements.

Requirements

Bachelor's Degree or equivalent experience
7 years of relevant healthcare or Medicare Advantage experience
Experience working with delegated or risk-based provider arrangements
Experience leading cross-functional initiatives
Experience presenting to executive provider leadership
Experience managing complex provider relationships
Demonstrated performance improvement leadership
Advanced technical skills for functional area
Advanced problem-solving skills and critical thinking capabilities that tie to functional strategy
Advanced technical skills for functional area
Advanced ability to partner with variety of functions across the enterprise
Advanced experience developing relationships with all provider types

Responsibilities

Serves as the senior strategic contact and primary escalation point for assigned high-complexity provider organizations, including IPAs, MSOs, medical groups, hospitals, and ancillary partners, maintaining executive-level engagement, accountability, and alignment with SCAN’s strategic, financial, and regulatory objectives.
Owns and drives regional provider performance strategy across assigned markets, delivering measurable improvements in quality outcomes, utilization management, cost performance, risk adjustment, network adequacy, access, and growth initiatives, while ensuring consistent execution of enterprise performance priorities.
Leads complex performance reviews and executive-level governance forums with provider leadership, translating multi-dimensional performance data into actionable improvement plans that advance quality, financial sustainability, and operational effectiveness.
Partners cross-functionally at a senior level with Contracting, Network Operations, Clinical, Quality, Analytics, and Growth teams to align enterprise strategies, coordinate provider initiatives, and ensure integrated execution across markets.
Analyzes provider-level performance data across regions to identify trends, risks, and opportunities; develops, implements, and monitors corrective action plans with defined milestones, governance oversight, and performance accountability.
Leads investigation and resolution of high-impact, multi-department escalations, conducting structured root cause analysis and implementing sustainable process and performance improvements that mitigate operational, financial, and regulatory risk.
Supports strategic contracting and provider partnership efforts by aligning operational readiness, performance expectations, and governance frameworks to ensure successful execution of contractual, delegated, and risk-based arrangements.
Provides subject-matter leadership by coaching and mentoring Provider Relations Leads, strengthening performance management capability, data fluency, executive presence, and consistency of provider engagement practices across the team.
Ensures provider alignment with regulatory, contractual, delegation oversight, and compliance standards, proactively identifying and addressing risks to support sustained performance, audit readiness, and organizational integrity.
Drives continuous improvement initiatives across assigned markets that enhance provider experience, operational efficiency, and performance accountability, while advancing scalable best practices and enterprise consistency.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.

Benefits

An annual employee bonus program
Robust Wellness Program
Generous paid-time-off (PTO)
11 paid holidays per year, plus 1 additional floating holiday
Excellent 401(k) Retirement Saving Plan with employer match
Robust employee recognition program
Tuition reimbursement
A competitive compensation and benefits program;
An annual employee bonus program;
Generous paid-time-off (PTO);
Eleven paid holidays per year;
Excellent Retirement Savings program;
A work-life balance;
An opportunity to become part of a team that makes a difference to our members and our community every day!