Provider Relations and Performance Specialist III

L.A. Care; Los Angeles (CA); On-site; USD 89,000 - 142,000; Full time

Benefits offered by this job

Paid Time Off (PTO)

Tuition Reimbursement

Retirement Plans

Medical, Dental and Vision

Wellness Program

Job summary

L.A. Care Health Plan in Los Angeles, CA, is seeking a Provider Relations and Performance Specialist III to drive engagement with the provider network and improve quality outcomes.

You will lead provider-facing interactions, monitor satisfaction, and apply data-driven approaches to resolve complex issues. Responsibilities include lifecycle management of provider issues, cross-functional collaboration, and guidance to staff while supporting organizational priorities and member experience.

Qualifications

• Understanding of managed care operations.
• Proficient in developing corrective action frameworks and using dashboards to monitor performance.
• Strong analytical and problem-solving skills including root-cause analysis and data interpretation.
• Strong communication and relationship-management with internal and external stakeholders.

Responsibilities

• Manages provider-facing interactions by ensuring orientation, onboarding, and ongoing education are delivered reliably.
• Monitors provider satisfaction indicators and performance trends to identify disputes, operational challenges, and relationship concerns.
• Facilitates structured provider forums and operational meetings to promote transparency and collaboration across provider segments.
• Manages the full lifecycle of complex provider issues from intake through root cause analysis, resolution planning, and implementation.
• Evaluates challenges based on financial impact, member implications, regulatory risk, and operational complexity to develop scalable solutions.
• Collaborates with internal partners across cross-functional departments to inform discussions and drive data-driven improvements.

Skills

Managed care operations

Data-driven improvements

Analytical skills

Communication & stakeholder mgmt

Education

Bachelor's degree in Healthcare Administration or related field

Equivalent education and/or experience considered

Job description

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Provider Relations and Performance Specialist III

Job Category: Provider Relations

Department: Provider Network Management

Location: Los Angeles, CA, US, 90017

Position Type: Full Time

Requisition ID: 13361

Salary Range:$88,854.00(Min.) -$115,509.00(Mid.) -$142,166.00(Max.)

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

Job Summary

8 open positions:

The Provider Relations and Performance Specialist III serves as the primary liaison between the health plan and its provider network, driving strategic engagement and operational excellence. This position establishes and maintains collaborative relationships with its network partners to support organizational priorities, provider performance, quality outcomes, and member experience.

The Specialist III leads provider-facing interactions, monitors provider satisfaction and performance indicators, and proactively addresses relationship concerns. The Provider Relation and Performance Specialist III manages the full lifecycle of complex provider issues, applying structured analysis and problem-solving approaches to develop effective and scalable solutions across provider segments. The Specialist aligns cross-functional stakeholders, leverages data and analytics to inform performance improvement strategies, and provides guidance to others. This position advances provider relations through disciplined, data-driven practices aligned with organizational objectives. Acts as a Subject Matter Expert (SME), serves as a resource and mentor for other staff

Duties

Manages provider-facing interactions by ensuring orientation, onboarding, and ongoing education are delivered reliably and consistently. Monitors provider satisfaction indicators and performance trends to identify emerging disputes, operational challenges, and relationship concerns. Facilitates structured provider forums and operational meetings to promote transparency, clarify complex issues, and strengthen collaborative relationships across all provider segments.

Manages the full lifecycle of complex provider issues from initial intake through root cause analysis, resolution planning, solution development, implementation, and post-resolution validation. Evaluates complex provider challenges based on financial impact, member implications, regulatory risk, and operational complexity to identify emerging issues, develop sustainable solutions, and ensure accurate, scalable support across provider segments.

Collaborates with internal partners across cross-functional departments. Leverages analytics and operational dashboards to inform provider discussions, identify recurring concerns, and develop data-driven, measurable, and sustainable improvement strategies aligned with organizational objectives.

Fosters a culture of accountability, responsiveness, analytical rigor, and service excellence by reinforcing standardized processes, documentation practices, and data-driven decision making. Supports organizational readiness and elevates team performance.

Applies subject matter expertise in evaluating business operations and processes. Identifies areas where technical solutions would improve business performance. Consults across business operations, provides mentorship, and contributes specialized knowledge. Ensures facts and details are correct so that the program's deliverable meets the needs of the department, organization and legislation's policies, standards, and best practices. Provides training and recommends process improvements as needed.

Performs other duties as assigned.

Education Required

Bachelor's Degree in Healthcare Administration or Related Field

In lieu of degree, equivalent education and/or experience may be considered.

Education Preferred

Experience

Required:

At least 4 years of progressive experience in a health plan, managed care, hospital, physician organization, Independent Practice Association (IPA), or provider relations environment.

Experience managing complex provider relationships and collaborating with senior leadership.

Preferred:

Experience with Medi-Cal, Medicare Advantage, Department of Health Care Services (DHCS), Department of Managed Health Care (DMHC), Centers for Medicare and Medicaid Services (CMS), and National Committee for Quality Assurance (NCQA).

Skills

Required:

Understanding of managed care operations and delegated risk environments.

Proficient in developing corrective action frameworks and utilizing operational dashboards to monitor performance, identify trends, and support data-driven improvements.

Strong analytical and problem-solving skills, including root-cause analysis, operational improvement, data interpretation, sound decision-making, and Service Level Agreement (SLA) governance.

Strong communication and relationship-management skills, with the ability to build collaborative partnerships with internal and external stakeholders.

Preferred:

Knowledge of capitation, value-based care models, and provider contracting.

Licenses/Certifications Required

Licenses/Certifications Preferred

Required Training

Physical Requirements

Light

Additional Information

Required: Travel to offsite locations for work required.

Salary Range Disclaimer: The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change.

L.A. Care offersa wide range of benefits including

• Paid Time Off (PTO)
• Tuition Reimbursement
• Retirement Plans
• Medical, Dental and Vision
• Wellness Program

Nearest Major Market: Los Angeles Job Segment: Healthcare Administration, Relationship Manager, Medicare, Medicaid, Healthcare, Customer Service