Provider Relations Lead - So Cal

SCAN Health Plan; Long Beach (CA); À distance; USD 72 000 - 123 000; Plein temps

Avantages offerts par ce poste

Annual bonus

Wellness program

PTO

Holidays

401(k) match

Remote work

Tuition reimbursement

Employee recognition

Résumé du poste

SCAN Health Plan is seeking a Provider Relations Lead to strengthen provider relationships across Southern California. The role focuses on executing performance initiatives, engaging providers, and driving KPIs such as star ratings, cost of care, and regulatory compliance.

The ideal candidate has 5+ years in healthcare or Medicare Advantage, strong data analysis, and cross-functional collaboration skills, with a mostly remote work mode and competitive benefits.

Qualifications

• 5 years of healthcare or Medicare Advantage experience.
• Bachelor's Degree or equivalent experience preferred.
• Provider relationship management experience.
• Data interpretation and performance analysis skills.
• Medicare Advantage and Star quality knowledge.
• CMS regulatory and compliance awareness.
• Ability to manage multiple priorities in a fast-paced environment.
• Escalation management and issue resolution abilities.
• Operational execution and follow-through.
• Presentation and facilitation skills.
• Cross functional collaboration skills.
• Strong written and verbal communication.
• Strong problem solving and critical thinking capabilities.
• Strong technical skills for Office tools and Visio.

Responsabilités

• Act as the primary operational liaison between SCAN and provider organizations within a defined region.
• Manage FFS network for Southern California.
• Execute and monitor regional provider performance initiatives and KPIs.
• Conduct regular operational touchpoints and Joint Operating Committee meetings.
• Partner with Network Contracting, Operations, Clinical, Quality, Growth, and Analytics teams.
• Support provider onboarding and lifecycle management with Contracting and Operations.
• Investigate and resolve provider escalations and high-risk issues.
• Deliver provider education and training on SCAN programs and regulatory requirements.
• Analyze provider-level data to identify trends and opportunities; drive corrective actions.
• Ensure regulatory and contractual compliance; identify risk areas.
• Support internal communication of network changes and market insights.
• Manage department Provider Relations Inbox.
• Contribute to SCAN’s Vision and Goals.

Connaissances

Provider relations

Healthcare operations

Data interpretation

CMS regulations

Communication skills

Cross-functional collaboration

Office tools

Formation

Bachelor's degree

Equivalent experience

Outils

Microsoft Office

Visio

Excel

PowerPoint

Outlook

Description du poste

Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do.

Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults.

Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity.

At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.

The Job

The Provider Relations Lead is responsible for managing and strengthening provider relationships within an assigned geographic region, with a primary focus on executing performance initiatives across quality, cost, utilization, access, and regulatory metrics.

This role serves as the primary operational liaison between SCAN and contracted providers, driving performance execution, provider engagement, and the achievement of key performance indicators (KPIs) such as star ratings, cost of care management, and risk adjustment (coding quality). This role is critical to developing deep relationships with providers and understanding how they operate, in order to drive performance.

The Provider Relations Lead serves as the primary point of contact and “quarterback” for provider relationships, demonstrating a strong account management mindset and a commitment to exceptional customer service. This individual proactively anticipates provider needs, responds promptly to inquiries, and takes full ownership and accountability for resolving issues and driving results; applies critical thinking and intellectual curiosity to deeply understand provider organizations, exhibiting abilities with navigating complex organizations and building trust with a variety of stakeholders; demonstrates both breadth and depth of knowledge—capable of engaging across a wide range of topics and diving deep to resolve complex challenges as needed; effectively project manage provider needs and initiatives, presenting confidently to diverse provider audiences and tailoring communication strategies to the in different nuanced scenarios order to develop actionable solutions.

You Will

• Acts as the primary operational liaison between SCAN and assigned provider organizations (MSOs, IPAs, medical groups, PCPs, specialists, hospitals, and ancillaries) within a defined geographic region.
• Will be responsible for managing FFS network for Southern California.
• Executes and monitors regional provider performance initiatives aligned to SCAN’s key performance indicators, including Star ratings, cost of care, utilization management, access standards, and quality measures to improve quality, cost, utilization, access and regulatory compliance to enhance quality, cost, etc.
• Conducts regular operational touchpoints and Joint Operating Committee meetings with providers to review performance results, identify gaps, and support action planning.
• Partners cross‑functionally with Network Contracting, Network Operations, Clinical, Quality, Growth, and Analytics teams to ensure coordinated provider engagement and issue resolution.
• Supports provider onboarding and lifecycle management in collaboration with Contracting and Operations, ensuring clarity of performance expectations and operational readiness.
• Investigates and resolves provider escalations and operational concerns, escalating complex or high‑risk issues to senior leadership when appropriate.
• Delivers provider education and training related to SCAN programs, policies, regulatory requirements, performance standards, and operational best practices.
• Analyzes provider‑level data to identify trends and opportunities, supporting corrective action plans and continuous performance improvement efforts. Utilize operational levers to drive performance improvements such as workflow optimization and process enhancements.
• Ensures provider alignment with regulatory, contractual, and compliance requirements, proactively identifying potential risk areas.
• Supports internal communication of network changes, provider performance updates, and market‑level insights to relevant enterprise stakeholders.
• Responsible for managing department Provider Relations Inbox.
• We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
• Actively support the achievement of SCAN’s Vision and Goals.
• Other duties as assigned.

Your Qualifications

• 5 years of relevant healthcare or Medicare Advantage experience; experience working with provider organizations or healthcare operations; experience with delegated or risk‑based provider arrangements; experience supporting provider performance improvement initiatives; experience presenting data to provider or operational audiences.
• Bachelor's Degree or equivalent experience preferred.
• Provider relationship management experience. Strong experience developing relationships with all provider types.
• Data interpretation and performance analysis skills.
• Medicare Advantage and Star quality knowledge.
• CMS regulatory and compliance awareness.
• Ability to manage multiple priorities and concurrent workstreams, effectively multi‑task, and remain organized and responsive in a fast‑paced dynamic environment,
• Escalation management and issue resolution abilities.
• Operational execution and follow‑through.
• Presentation and facilitation skills.
• Accountability and ownership mindset.
• Strong problem solving skills and critical thinking capabilities
• Strong written and verbal communication and interpersonal skills.
• Cross functional collaboration skills. Strong ability to partner with variety of functions across the enterprise.
• Strong technical skills for functional area. Advanced Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, Access) and Visio.

What's in it for you?

• Base salary range: $71,700 to $123,490per year
• Internal title: Provider Relations II
• Work Mode: Mostly Remote
• An annual employee bonus program
• Robust Wellness Program
• Generous paid‑time‑off (PTO)
• Eleven paid holidays per year, plus 1 floating holiday, plus 1 birthday holiday
• Excellent 401(k) Retirement Saving Plan with employer match and contribution
• 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!

At SCAN we believe that it is our business to improve the state of our world. Each of us has a responsibility to drive Equality in our communities and workplaces. We are committed to creating a workforce that reflects our community through inclusive programs and initiatives such as equal pay, employee resource groups, inclusive benefits, and more.

SCAN is proud to be an Equal Employment Opportunity and Aff ... \"Individuals seeking employment will receive consideration for employment without regard to race, color, national origin, religion, age, sex (including pregnancy, childbirth or related medical conditions), sexual orientation, gender perception or identity, age, marital status, disability, protected veteran status or any other status protected by law. A background check is required.

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities