Sr. Provider Relations Manager, Southern California

SCAN Health Insurance•California, MO

2d•Remote

About The Position

The Senior Provider Relations Manager will be responsible for building and maintaining effective provider relationships with medical groups and their associated primary care physicians, specialists, hospitals and ancillaries. The Senior Provider Relations Manager will directly own relationships with the senior executives at the largest provider groups in the region, and manage the end-to-end operational interface with these providers across all contractual fee types and risk arrangements. This individual will drive strategic dialogue and planning with providers, including driving cross-functional process improvements to ensure a positive provider experience. This role will manage a team of locally based Provider Relations individuals across SCAN’s Southern California market. This Senior Manager will be a key strategic leader in driving performance across Star, coding quality, and cost of care management in this critical market. This includes a deep understanding of operational levers that drive improvements in these key performance measures, and proven experience building deep relationships with provider networks in order to influence these actions with the provider. The job entails partnering closely with Network Management Contracting counterparts to facilitate an integrated provider onboarding process, conducting provider awareness and orientation about SCAN Health Plan, ongoing education and outreach, relationship building with office staff and providers, and quarterbacking the overall relationship including acting as the liaison with cross-functional stakeholders across reporting needs, performance monitoring, issue resolution, and clinical programs or growth efforts with the medical group and their providers. The Senior Provider Relations Manager will partner with the SCAN Southern California General Manager, Regional Medical Director, clinical and performance leadership, growth leadership and other enterprise teams to ensure strategic initiatives with the providers are coordinated and cohesive. The engagement will be at all levels of the provider network, including with MSOs, IPAs, and medical groups. There will be daily interface with office staff and providers, as well as interactions with corporate leadership at medical groups and constant collaboration with internal stakeholders to effectively establish and maintain a positive provider experience and resolve escalated issues in a timely manner.

Requirements

Bachelor's Degree or equivalent experience
Minimum 10 years of experience in healthcare, Medicare Advantage, managed care, or provider network operations.
Minimum 7 years of leadership experience managing professional teams.
Experience managing delegated and/or risk-based provider arrangements.
Demonstrated experience engaging executive-level provider leadership.
Ability to build, influence, and sustain trust-based relationships with senior leadership at medical groups, IPAs, MSOs, and large health systems (e.g., Sutter).
Demonstrated ability to drive measurable provider performance across quality, utilization, risk adjustment, cost management, and growth metrics.
Strong understanding of Medicare Advantage economics, delegated risk models, capitation structures, and value-based care arrangements.
Ability to analyze complex performance reports, identify trends, translate data into actionable insights, and lead corrective action planning.
Skilled at coordinating across Contracting, Network Operations, Clinical, Growth, Delegation Oversight, Claims, UM, and Provider Data Management to drive enterprise-aligned solutions.
Ability to develop and execute market-level provider strategies aligned to membership growth, network adequacy, and regulatory requirements.
Strong project management skills to resolve complex, high-risk provider escalations with structured follow-through and executive communication.
Working knowledge of Medicare Advantage regulations, delegated oversight requirements, network adequacy standards, and compliance expectations.
Ability to lead through ambiguity, drive provider-facing transformation, and support internal operating model shifts.
Highly developed written, verbal, and presentation skills, including experience leading Joint Operating Committees (JOCs) and executive performance reviews.

Nice To Haves

Graduate or Advanced Degree or equivalent experience
Experience leading provider performance governance in a multi-state Medicare Advantage environment.
Direct experience managing large strategic provider partnerships (e.g., integrated delivery systems, large MSOs).
Experience working within value-based care or population health models.

Responsibilities

Own executive-level relationships with large, high-complexity provider organizations (including Sutter) and serve as SCAN’s senior market liaison for delegated and risk-based arrangements.
Drive provider performance accountability across quality metrics, utilization management, risk adjustment, cost performance, network adequacy, and growth initiatives.
Lead geographically aligned Provider Relations Leads and Senior Provider Relations Leads, ensuring clear market ownership and measurable performance outcomes.
Partner with Network Management Contracting to align performance expectations with contractual terms and delegated arrangements.
Oversee executive escalation governance and resolve complex, cross-functional provider issues through structured project management and enterprise collaboration.
Lead Joint Operating Committees (JOCs) and executive performance reviews with MSOs, IPAs, and medical groups.
Collaborate with Southern California General Manager, Regional Medical Director, Clinical Leadership, Growth, and Operations teams to align provider strategy with market objectives.
Monitor provider-level data and analytics to identify performance gaps and drive corrective action plans in partnership with internal subject matter experts.
Ensure regulatory compliance across delegated oversight, network adequacy, and Medicare Advantage operational requirements.
Champion initiatives that improve provider experience while maintaining performance discipline and enterprise accountability.
Actively support the achievement of SCAN’s Vision and Goals.
Other duties as assigned.

Benefits

Base Pay Range: $125,400 - $215,975 Annually
Work Mode: Mostly Remote
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
An opportunity to become part of a team that makes a difference to our members and our community every day!