Head of Provider Relations & Issue Resolution

L.A. Care Health Plan; Los Angeles (CA); On-site; USD 150,000 - 254,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Volunteer Time Off (VTO)

Job summary

L.A. Care Health Plan seeks a Director of Provider Relations and Resolution Management to strengthen partnerships with provider groups, hospitals, and ancillary services.

You will lead a team delivering timely issue resolution, navigate plan requirements, and implement proactive processes to reduce friction and improve provider satisfaction. The role requires leadership across executive relationships, root-cause analysis, and measurable improvements aligned with Medi-Cal, Medicare, DMHC, DHCS,

Qualifications

• 8+ years of progressive experience in health plan/provider relations settings.
• 6+ years in leading staff and managing people.
• 5+ years in provider-facing leadership with executive relationships.
• Familiarity with Medi-Cal, Medicare Advantage, DMHC, DHCS, CMS, NCQA is preferred.

Responsibilities

• Lead provider-facing interactions and ongoing education on policies and tools.
• Oversee provider satisfaction, monitor disputes and escalation patterns.
• Manage end-to-end provider issue lifecycle from intake to resolution.
• Collaborate with cross-functional teams to implement system-level fixes.
• Mentor and develop a high-performance provider relations team.
• Set goals and manage hiring, performance reviews, and budgets.
• Lead policy discussions and ensure SLA governance.

Skills

Managed care operations

Delegated risk management

Dashboard analytics

Executive communication

Stakeholder relationship

Strategy development

Change leadership

Decision making

Education

Master's Degree

Equivalent experience considered

Job description

L.A. Care Health Plan seeks a Director of Provider Relations and Resolution Management to strengthen partnerships with provider groups, hospitals, and ancillary services.

You will lead a team delivering timely issue resolution, navigate plan requirements, and implement proactive processes to reduce friction and improve provider satisfaction. The role requires leadership across executive relationships, root-cause analysis, and measurable improvements aligned with Medi-Cal, Medicare, DMHC, DHCS,